A recurrent hernia — one that comes back after a previous operation — is one of the most disheartening problems a patient can face. Modern recurrence rates are low (1–5%), but they are not zero, and the chance is higher with certain hernia types, patient factors and surgical techniques. The good news is that re-do hernia repair, when planned and performed correctly, has excellent results. This guide explains why hernias recur and how we approach the second operation.
Why do hernias come back?
- •Technical: mesh too small, poor fixation, missed second hernia
- •Patient: smoking, obesity (BMI > 30), uncontrolled diabetes, COPD, chronic cough or constipation
- •Lifestyle: returning to heavy lifting before 6 weeks
- •Tissue: collagen disorders, steroid use, malnutrition
How recurrent hernia presents
A bulge in or near the previous scar that appears on coughing or straining, sometimes with dragging pain. Some recurrences are silent and found incidentally on a scan.
How we assess
- •Clinical examination standing and supine, with cough impulse
- •Dynamic ultrasound — usually diagnostic
- •CT abdomen with Valsalva — for complex or ventral recurrences, maps the defect and the position of any previous mesh
- •Optimisation of weight, glycaemic control and smoking cessation pre-operatively
Surgical strategy
The principle is to repair through a fresh tissue plane:
- •Open repair recurrence → laparoscopic (TAPP/TEP) repair
- •Laparoscopic recurrence → open Lichtenstein or robotic repair
- •Large or complex ventral recurrence → component separation + sublay mesh
Modern wide-coverage mesh and atraumatic fixation (glue, absorbable tacks, self-fixating mesh) minimise the chance of a third recurrence.
Reducing recurrence after re-do surgery
- •Stop smoking 6 weeks before and 6 weeks after
- •Optimise BMI (target < 30)
- •HbA1c < 7.0 for diabetic patients
- •Treat chronic cough or constipation pre-op
- •Strict adherence to 6-week post-op lifting restriction