Dr Harsh Shah
MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Registered with Gujarat Medical Council, Reg. No. G-38738
Robotic Hernia Surgeon · Apollo Hospital, Bhat, Gandhinagar · Gota OPD, Ahmedabad
In short
A hernia that returns is disheartening. It is also common enough that there is a settled way of dealing with it.
The important idea is this. A second repair is not the first one done again. It is a different operation, planned around what was done before.
Several things push the rate up. A mesh that was too small for the gap. Tension on the closure. A wound infection. Smoking. Poorly controlled sugar. A cough or straining that never settled.
Sometimes none of these applies and it still comes back. Tissue quality varies between people, and that is not anybody's fault.
A CT scan, often taken while you strain, shows where the new gap is, how big it is, and where the old mesh sits. Guessing any of these from the outside is unreliable.
Bring the earlier operation note if you have it. Which route was used and what mesh went in changes the plan more than anything found on examination.
The principle is simple. Approach the hernia through a plane nobody has operated on.
So a groin hernia first repaired from the front is usually redone from behind, by keyhole or robotic surgery. One repaired from behind is often redone from the front. Scar tissue is slow to work through and it hides the nerves and the cord.
The old mesh is usually left alone. It is stuck to tissue by design. Taking it out is a long, bloody step that rarely helps, and it is reserved for an infected mesh or one that is clearly causing the trouble.
What decides the plan for a second repair
| What we need to know | Where it comes from | What it changes |
|---|---|---|
| Which operation was done | The earlier operation note | Whether the front plane is usable |
| Was mesh used, and what kind | The note, or the mesh sticker | The plane chosen this time |
| Where the new defect is | A CT scan, often done straining | The size of the repair |
| How long since the first repair | Your own account | How much scar tissue to expect |
| Any wound infection last time | The discharge summary | Whether mesh is safe here |
| Smoking, sugar control, weight | Clinic review | How well this repair will hold |
Bring the earlier operation note and any scan. What was done the first time decides most of the plan for the second.
A second repair usually takes longer in theatre than the first. Recovery is broadly similar, sometimes a little slower.
It is worth fixing what you can beforehand. Stopping smoking, getting sugar under control and treating a chronic cough all change how well this repair holds.
It depends on the hernia and on the first repair. Groin hernias repaired with mesh come back in a small minority. Large incisional hernias come back far more often. Your own figure depends on the gap, the mesh used and your health.
Usually not. It is stuck to tissue on purpose, and removing it is slow and bloody. It is taken out when it is infected, or when it is clearly the cause of the problem.
It is a longer and more demanding operation, and the risk of nerve injury and of fluid collections is higher. Planned carefully, with the right plane chosen, it remains a safe operation for most people.
In almost every case, yes. The scan shows the new defect, its size and the position of the old mesh. Planning a second repair without it means operating on a guess.
Often, and it is a good fit. The robot reaches the plane behind the muscle that a front repair never entered, and it gives a clear view of the whole groin.
The main page on this site is robotic hernia surgery in Ahmedabad. These cover the neighbouring questions. If your hernia has come back, read about planning a robotic repair for a recurrent hernia.
Where to find us
Dr Harsh Shah, MS, MCh (Surgical Gastroenterology), DrNB (Surgical Gastroenterology)
Shah's Gastro, Cancer & Robotic Surgery Centre
Apollo Hospital, Bhat, Gandhinagar
Gota OPD, Ahmedabad
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