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, 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