1394 sokak No: 11 Sağlık Merkezi Apartmanı. Kat: 4 Daire: 10 Alsancak - İzmir
The primary goal in hernia surgery is to prevent recurrence of the repair. The most important reason for recurrences is the tension of the repair. That's why patching is used. With patching, repairs can be made without tension. Recurrent hernias should definitely be repaired with a patch.
In the recurrence of inguinal hernias, if the repair was performed with the open method, it should be repaired laparoscopically. If the laparoscopic repair has recurred, an open repair is recommended. However, recurrence of laparoscopic repair can be successfully repaired laparoscopically in experienced hands.
Reasons
While there is no clear reason why a hernia repair might recur, there are some key patient factors and surgical factors that can cause a patient to relapse:
– Some congenital diseases with connective tissue disorder
– Chronic steroid use
– Very early activity after surgery
– Obesity
– Smoking, COPD, chronic cough
– Insufficient size of the first patch or insufficient fixation
– Inexperienced surgeon
Problems in recurrent hernias
Sometimes the hernia is very large, in which case a laparoscopic repair will not provide a proper repair for the function of the abdominal wall. In some laparoscopic repairs, the hernia hole is left open. This is not a problem in patients with small hernias. But if the hernia hole is large, the patch placed does not bring the abdominal wall to a suitable functional state. In such cases, the patch will overflow with the hernia hole. This is not a desirable situation. With hernias like this, an open approach is required. By making the surgery open, the hernia hole is closed, and the muscles are brought together, the abdominal wall can function normally.
It should not be forgotten that the abdominal wall is complex. This sometimes requires advanced techniques (component separation) to allow a stress-free repair. In this technique, a patch may be placed under the muscle, and sometimes over the muscle, to strengthen the repair and reduce the likelihood of recurrence.
Studies show that each time a hernia is repaired after its recurrence, the likelihood of recurrence increases dramatically. In patients who have already had 3-4 hernia repairs, the probability of recurrence can be almost 50%!
Complications after recurrent hernia surgeries are also more common. Recurrence of a relatively small inguinal hernia or an umbilical hernia carries as many increased risks as large ventral hernias. Obviously, scar from previous surgery makes surgery more difficult. Often, patch pieces placed in previous surgery or surgeries further complicate the repair. All of these result in a more difficult surgery with increased complications.
Studies indicate that it is best to go to specialists/centers for the treatment of recurrent hernias.
