This is a hernia that has recurred, after a previous repair of the hernia.

Experience of the surgeon
There is a lot of evidence that hernia recurrence is lower for the dedicated, experienced hernia surgeon. Such a surgeon is able to make the right decision on:

• the choice of surgical approach
• the type of mesh being used
• the type of suture used and the suturing technique.

Infection
Up to 50% of hernia recurrence is due to the presence of infection. One third of infected groin hernia will result in hernia recurrence.
 

These factors include obesity, chronic debilitating disease, immunosuppression (lowered immunity) and liver disease.

Smoking
There is a higher incidence of hernia recurrence amongst smokers. This is due to not only the chronic cough causing increased mechanical stress of the hernia repair site. There is also increased levels of enzymes that interfere with wound healing.

Size of the hernia
The larger the hernia the higher the recurrence rate.
The surgical repair of a large hernia may result in a tensioned repair. This will make a recurrent hernia more likely.

More information

The repairs of these hernias are more complicated than the repair of a ‘normal/primary’ hernia.

It involves approaching the repair through an area not affected by scar tissue resulting from the previous surgery. This may be achieved through an incision directly on the front of the abdominal muscle, with the hernia being repaired from the front of the muscle layers.
Alternatively, the hernia may be better repaired from behind the muscle (within the abdominal cavity – ‘laparoscopic’ approach or keyhole surgery) or just between the muscle layer and abdominal cavity (preperitoneal/extraperitoneal approach).

If the hernia defect is large and the surrounding muscle is of poor tone, an abdominal wall reconstruction may be needed. (see: abdominal wall reconstruction).

The experience and training of the surgeon is critical in making the right decision on the choice of approach. A dedicated hernia surgeon should have the experience to offer a number of alternative approaches to the repair.

These repairs are considered major surgery and will require you to stay in hospital for several days.

Please also see: Hernia – overview