A recurrent hernia is a hernia that reappears after a previous surgical repair. It can affect the umbilical or inguinal region or other areas of the abdominal wall, including previously operated incisional hernias.
Treating a recurrence requires particularly careful planning: the tissues have already undergone surgery and there may be
- scarring
- adhesions
- previously implanted meshes
The aim is to correct the defect and achieve a stable and lasting reconstruction, minimising the risk of further recurrences.
Why is it important to avoid new recurrences?
Repeated operations can cause
- alteration of the anatomical planes
- fibrosis
- adhesions
- progressive deterioration of the abdominal wall tissues
In the most complex cases, a succession of recurrences and reoperations can contribute to the development of severe abdominal wall defects, up to so-called complex abdomen or abdominal wall disaster.
The aim should be to operate only once, with a reconstruction that is as definitive as possible.
No technique can guarantee the complete absence of recurrence, but correct planning can help reduce the risk.
Which recurrent hernias can be treated with minimally invasive methods?
All of them.
Recurrent umbilical herniaReappearance of the defect in the umbilical region after a previous repair.
Recurrent incisional herniaA new hernia developing at a surgical scar that has already been repaired.
Recurrent inguinal herniaReappearance of an inguinal hernia after traditional or minimally invasive surgery.
Other recurrent herniasEpigastric, femoral, lateral hernias and those in other areas of the abdominal wall.
The advantages of minimally invasive surgery in recurrences
General benefits:
- small incisions
- less trauma to the wall
- rapid postoperative recovery
- lower risk of infection
Specific benefits in recurrences:
Accessing the peritoneal cavity
To explore the abdomen and perform, when indicated, adhesiolysis, i.e. releasing adhesions between the viscera and surrounding structures.
Remaining completely extraperitoneal
Reconstructing the wall without entering the abdominal cavity and without necessarily dealing with visceral adhesions unless needed
Using virgin planes, not used in the first operation
Which minimally invasive techniques can be used?
Treating recurrent hernias may require different techniques, selected according to
- location of the defect
- characteristics of the previous repair
- patient characteristics
- position of a previously implanted mesh
TAR – Transversus Abdominis Release
A posterior component separation technique that enlarges the retromuscular space and allows complex abdominal wall defects to be reconstructed, with the option of mesh reinforcement.
miSAR® and p-miSAR®
Minimally invasive abdominal wall reconstruction techniques which, in selected patients, allow midline reconstruction and the placement of a reinforcing mesh. The p-miSAR® variant uses an extraperitoneal approach.
eTEP – Extended Totally Extraperitoneal
A minimally invasive approach that works in the extraperitoneal and retromuscular planes, avoiding entry into the peritoneal cavity where possible.
Can a mesh from the previous operation be removed?
Yes, in some cases a previously implanted mesh can be removed.
Whether removal is feasible and advisable depends on several factors:
- Anatomical plane in which the mesh was placed.
- Type of material and degree of integration into the tissues.
- Presence of adhesions to abdominal organs.
- Any mesh complications.
- Need to use the same anatomical plane for the new reconstruction.
Removal can also be performed with minimally invasive techniques.
However, removing a previous mesh is not always necessary or beneficial. If it causes no problems and does not hinder the new repair, keeping it may be the safest choice.
The decision requires specialist assessment and careful surgical planning.
How is the treatment of a recurrent hernia planned?
The assessment includes a specialist consultation, analysis of previous operations and anatomical study of the abdominal wall.
- Specialist consultation
- Analysis of previous operations
- Anatomical study of the abdominal wall
CT with ValsalvaCT scan of the abdominal wall during a Valsalva manoeuvre, to define the size of the defect and the structures involved and to plan the reconstruction.
The aim is to identify a personalised strategy that allows an effective reconstruction while trying to preserve the anatomical planes still available.
A previously operated hernia deserves a different strategy.
Each new operation can make reconstruction more complex.
A specialist assessment makes it possible to plan a personalised repair, including with minimally invasive techniques, aiming for maximum stability over time.
Frequently asked questions
Can a hernia come back after it has been operated on?
Yes. A recurrence can occur even after surgical repair. The risk depends on several factors, including the technique used, the characteristics of the defect and the condition of the tissues.
Can a recurrent hernia be operated on laparoscopically?
Yes. Many recurrent hernias can be treated with minimally invasive laparoscopic or robotic techniques, choosing the most appropriate approach according to previous operations.
Is it necessary to enter the abdominal cavity?
Not always. Some techniques allow a completely extraperitoneal reconstruction, avoiding where possible entry into the abdominal cavity and unnecessary release of adhesions.
Does the mesh from the previous operation need to be removed?
Not necessarily. Removal depends on the position of the mesh, its condition and the needs of the new reconstruction.
Why is operating on the same hernia several times more difficult?
Each operation can alter the anatomical planes and cause scarring and adhesions. This can increase the complexity of subsequent reconstructions.