Hernia recurs in about 10% of the patients who have undergone a primary inguinal herniorraphy. A second repair of such a hernia can be daunting. It requires the expertise and precision of an experienced surgeon. It is a delicate surgery because the tissues have already weakened and the anatomy is obscured and distorted. A definite repair approach for a recurrent hernia is the laparoscopic approach due to the high rate of failures with the open anterior approach. Laparoscopic repair of the recurrent hernia is proven to be one of the safest alternative procedures with minimal complications.
Why do hernias recur?
Patients undergo hernia surgery with the thought that it would not occur again. But unfortunately this may not the case. Relapse of the hernia can occur in the same place. A mesh is a small synthetic material stitched on to the hernial hole to prevent recurrence. Most hernias are external and palpable with the maximum being groin hernias. The incidences of abdominal wall hernias are also high. Our intestines are protected by three layers of muscles and when there is damage to this protective muscle tissue, hernias occur. To combat this, the repair surgery will remove the hernial sac and replace it with a mesh. A curtain is formed on the weak area. Healing time for the mesh to penetrate itself into the body can take 2 to 3 years. It is during this time that when a patient gets strenuous attacks of coughing and sneezing or resorts to extreme physical strain, the mesh is torn. This leads to a recurrence in hernia.
Recurrent hernias can lead to dangerous complications of incarceration and strangulation if left untreated. Relaparoscopic repair is done to prevent enlargement of a recurrent hernia. Characteristics of the recurrent hernia are:
- Visible bulge or lump in the area of previous hernia
Diagnosis of a recurrent hernia is fairly simple but obese individuals may require more complex diagnostic methods. Recurrent inguinal hernias are a consequence of errors in judgment and surgical technique. Repairs can also fail due to metabolic problems of the groin tissue. More frequently, surgeons fail to notice the evident presence of a double hernia and it is overlooked. For example, indirect recurrence happens due to incomplete dissection of the sac from the inguinal ring. An anterior mesh repair is a recommended procedure for a recurrent hernia after a posterior repair done previously. Both TAPP and TEP are preferred techniques for recurrent hernias.