Hernia repair surgery is one of the most if not the most common surgical procedures. But what many don’t know, is that hernia revision surgery is also extremely common. Meaning hernia surgeries that fail and require a surgery to repair the already operated-upon hernia. Of the roughly 200,000 repairs conducted in the United States each year, approximately 15% will require revision surgery. And the surgery is not a simple one. In fact, hernia revision surgery is even riskier than the initial repair.
Hernia Revision Surgery Options
There are two approaches to hernia repairs, and surgeons use both methods equally. Prosthetic mesh is the first approach, often used to reinforce the repair. It acts as a sort of bridge, or patch across the tear in the muscle. Surgeons use laparoscopic or open techniques to insert the mesh. Non-mesh surgeries typically involve sutures using absorbable materials.
There is a continued debate about which approach is the most ideal for repairing hernias. A recent study found that patients who received hernia mesh had a lower rate of hernia recurrence over five years. However, with long-term follow-up, the benefits were offset in part, by mesh-related complications. This is likely due to faulty mesh materials, such as Ethicon’s Physiomesh.
With either approach, patients can either undergo laparoscopic or open surgery. During a laparoscopic repair, the surgeon makes multiple small incisions in the abdomen. They then guide surgical tools through the openings to repair the hernia. Laparoscopic surgeries have the option of using or not using hernia mesh and are less invasive than the open approach.
During an open repair, there is only one incision near the hernia area, rather than several small incisions. There is also an option of either using or not using hernia mesh during the repair.
A 2013 study analyzed recurrence rates in laparoscopic and open surgeries. It found that recurrence rates were higher in the laparoscopic group (18%) versus open (14%). And while the technique is effective, with similar outcomes, post-operative complications are much higher with laparoscopic surgery.
Post-operative complications can include bowel restrictions, surgical site infections, and intestinal strangulation. Hernia recurrence is possibly the most common complication. And since this requires a second, often more serious surgery, the risk of additional perioperative complications increases.
What Causes Hernia Recurrence?
Hernia recurrence can occur for many reasons — some of which patients can avoid. Possible causes of requiring revision surgery include:
- Human error — Poor execution on the part of the doctor can cause recurrence. Many surgeons use an overlay mesh to patch the hernia. If improperly implemented it can cause hernia recurrence.
- Faulty materials — Faulty materials including hernia mesh and other surgical materials can lead to hernia recurrence. Lawsuits are being filed against Ethicon for their faulty mesh implant, Physiomesh.
- Weak fascia — The tissues surrounding an organ can weaken a hernia repair. This complication can also lead to another hernia in the area.
- Infection — An infection can prevent tissue from properly healing. Non-sterile materials, human error, faulty mesh and other factors can lead to an infection.
Risk Factors for Recurrence and Hernia Revision Surgery
Certain risk factors can increase your chances of requiring hernia revision surgery. They can place additional strain on your muscles, worsening an existing hernia or reopening a suture. Hernia recurrence risk factors include:
- Additional abdominal surgeries
- Additional abdominal injuries
*According to one study, obesity is the only significant risk factor for recurrence. 11% of obese patients experienced a hernia recurrence. Researchers recommend that obese patients receive mesh rather than suture repair.
The Risks of Hernia Revision Surgery
Hernia revision surgery can be even riskier than initial surgeries. Tissue damage and an open surgical site can cause additional complications. In fact, The British Hernia Center states that “the chances of success actually diminish with each successive attempt at repair.”
The United States Food and Drug Administration (FDA) reports some of the complications of revision surgery. These include:
- Adhesions — Scar-like tissue that sticks tissues together
- Bowel obstructions — Where there is a blockage in the small or large intestine
- Fistula — Abnormal connection between organs, vessels, and intestines
- Seroma — Fluid build-up at the surgical site
- Perforation — Hole in neighboring tissues or organs
It is also possible for hernia mesh to migrate to other areas of the body. Mesh can also shrink, and then contract — affecting blood flow.
Complications Requiring Emergency Hernia Revision Surgery
Most complications can be surgically repaired at a convenient time. But certain conditions necessitate emergency hernia revision surgery. Emergency complications include:
- Intestinal strangulation — Intestinal strangulation is a serious condition caused by a loop of the intestine trapped tightly in a hernia. Blood supply to that part of the intestine is cut off and tissue can die. In males, if the tissue dies, it can cause damage to the testicle and blood vessels.
- Bowel resection — Bowel resection means that a surgeon removes part or all of your small intestine. This is necessary when there is a blockage or disease in part or all of your bowel. A 2012 study shows that it is technically challenging as well. Diseased bowels contain inflamed and friable tissues. The study confirms, “a high rate of wound infection” can occur when a hernia is repaired with an associated bowel obstruction.
- Surgical site infection (SSI) — When surgical mesh is implanted during contaminated conditions, it often leads to SSI. Mesh repair has a small reduction in recurrence rates. However, the risks for seroma and SSI increases when mesh is involved.
What Injured Patients Can Do
Evidently, hernia repair surgery has links to serious risks and complications. While hernia recurrence occurs with both mesh and non-mesh, long-term complications are more likely with mesh. Mesh repairs can also require additional hernia revision procedures in the future.
If you or a loved one have required revision surgery after surgical mesh implantation, you’re not alone. Thousands have reported serious side effects to the FDA. You may be eligible for compensation to help offset the expense and pain and suffering associated with recurrence. To see in just minutes whether you may qualify for financial compensation, complete your free hernia claim evaluation today. Once you’ve submitted your information, an experienced advocate will call to schedule an in-person, confidential meeting to discuss compensation options.
Mandy Voisin is a freelance writer, blogger, and author of Girls of the Ocean and Star of Deliverance. As an accomplished content marketing consultant, mom of four and doctor's wife, Mandy has written hundreds of articles about dangerous drugs and medical devices, medical issues that impact disabled Americans, veterans' healthcare and workers' compensation issues since 2016.