One of the biggest 'complications' of hernia surgery is that the hernia can return after attempted repair. This happens to EVERY surgeon; no center has 100% success, including ours. However, we make every attempt at doing the most consistent hernia repair thereby reducing our recurrence rate to as low as medically possible.
At California Hernia Specialists we offer all possible options for definitive repair. This includes basic open repair, laparoscopic repair, and more advanced component separation and advanced mesh repairs. When needed, we work with outside surgeons during recurrent hernia repairs to ensure the best possible care. We discuss all options with each patient to ensure the best and most informed decision is made.
Some causes of recurrent hernias:
Although there is no clear reason why one hernia recurs and another doesn't, there are some basic patient factors and surgical factors that can predispose a patient to have a recurrence:
- Chronic steroid use
- Activity too early after surgery
- Smoking, COPD, chronic cough
- No mesh is used for repair
- Mesh not large enough to completely cover hernia
- Mesh not fixed to muscle strong enough
Laparoscopic Recurrent Hernia Repair
Recurrent hernias can be good candidates for laparoscopic hernia repair. This is because the muscles around the hernia are obviously weak; so much so that the muscles tore after an attempted repair. By using laparoscopic techniques, a larger piece of mesh can usually be placed allowing for all the weakened muscle to be repaired. Also, if the original surgery was done open, by operating laparoscopically previous scar tissue can be avoided.
A hernia mesh is rolled and placed through one of the laparoscopic ports into the abdomen. From there, it is pulled up against the muscle surrounding the hernia with stitches (sutures). Once the mesh is secured in place with about 4 sutures, a special stapling device is used to further fix the mesh to the healthy muscle.
Click below to review actual cases and their photos, images, and descriptions:
A 74 year old physician had a large pelvic tumor removed which was non cancerous. She developed a hernia 2 years after her surgery and underwent a laparoscopic incisional hernia repair at a large University Hospital in Southern California. Weeks after her surgery, she noticed a recurrent bulge in the lower part of her abdomen.
She presented to California Hernia Specialists for evaluation and treatment. On examination she had a 1-2 inch bulge in the lower abdomen, just above her pubic bone. This recurrent incisional hernia was painful when she exercised and while she was at work. We offered her laparoscopic recurrent incisional hernia repair.
The following video is a summary of her surgical procedure narrated by Dr. Harris.
Open Recurrent Hernia Repair
Sometimes a patients hernia is so large that a laparoscopic repair will not provide a suitable repair of the FUNCTION of the abdominal wall. With laparoscopic repair, the muscles are left open and are not closed. This works very well in patients with mid sized hernias. But once the hole becomes too large, placing a piece of mesh across a very large hole will not return the abdominal wall to a suitable functional state; there will always be a large bulge.
This is obviously not desirable. In these advanced cases, an open approach is required. By doing surgery open, the muscles can often be pulled back together. This sometimes requires advanced techniques (component separation) to allow a tension free repair. A mesh can be placed under the muscle and sometimes over the muscle to reinforce the repair for years to come and help prevent another recurrence.
Click below to review actual cases and their photos, images, and descriptions:
This patient had been operated on two previous times by an outside surgeon. The first surgery was done without mesh. After it recurred almost immediately, the same surgeon used a 'large piece of mesh' as was described by the patient and the operative report. Unfortunately shortly after this surgery, the bulge returned and the patient developed increasing pain.
The patient presented to California Hernia Specialists for a second opinion before returning for a third surgery. The patient underwent a physical exam and a CT scan to evaluate the size of the hernia. A number of options were presented to the patient and ultimately it was decided to treat him with an open recurrent umbilical hernia repair.
A 'tummy tuck' incision was used to help tighten and remove excess skin and the old scar. The old mesh had completely separated from the muscle and was stuck to the small intestines internally. Careful removal of the mesh was required to free the intestine from the hernia. The muscle was closed and a new piece of advanced mesh was placed under the muscle to reinforce the repair. The images below are from before and after his hernia surgery.
This image shows photos before his surgery along with the CT image corresponding to his hernia. The arrows point out the obvious hernia.
These 3 CT scan images show the patients muscle above the hernia where the muscle is normal, at the level of the hernia, and then below the hernia again where the muscle is normal.
In the images below we compare the pre-operative photos to the post-operative photos taken just 2 weeks after his surgery.
The patient continued to lose weight after his surgery. He was followed for 6 months and did very well throughout this time returning to normal activities after about 4-6 weeks.
2. Recurrent incisional hernia in a 54 year old male after cancer surgery.
A 54 year old gentleman had a small cancer removed from his stomach several years prior. After that initial surgery he did well, until he felt a lump. His surgeon diagnosed him with an incisional hernia and he was taken back to the operating room for repair of this hernia.
Despite the fact that the surgeon used a small mesh, after only a few months the patient felt a bulge in the same area. The surgeon then re-operated and placed a larger mesh. Almost immediately after this surgery, the patient felt a recurrent lump and fullness in the incision. He presented to California Hernia Specialists for evaluation.
This initial CAT scan image shows why the hernia repair continued to fail. There is very weakened muscle in the middle of the abdomen with most of the healthy muscle several inches away on each side. More likely than not, the prior surgeon simpley sewed the meshes into this unhealthy layer of fascia instead of bringing together the normal, healthy muscle.
After this CT scan was obtained, a lengthy discussion with the patient was undertaken to explain the reasons for the prior hernia repair failures, and to explain all the options. By simply returning to the operating room and putting in more mesh, and sewing it to unhealthy muscle, we would not be actually repairing the hernia.
The more complete approach would be to bring healthy muscle together at the midline. Only after the muscle is repaired completely, can a mesh be used to SUPPORT the muscle repair. Meshes should not be considered a bridge from healthy muscle to healthy muscle. Instead mesh should be used as a reinforcement of a correct hernia repair.
This technique requires more surgical time, recovery time, and usually several days in the hospital. However, this patient chose to proceed with the open hernia repair. Below are some of the pictures from his surgery as well as post operative CT scan image and photos of the patient.
Important points to consider when choosing a hernia surgeon:
- The newest, advanced lightweight mesh can reduce not only recurrence rates for hernias, but also reduces the chance of postoperative mesh pain to almost zero.
- Being treated at a specialized hernia center with an in-house accredited ASC provides the highest quality care before, during, and after your hernia surgery.
- Patients should be seen by a surgeon who can offer all forms of hernia surgery, including open lightweight mesh techniques, as well as advanced laparoscopic techniques. This ensures the surgeon can offer the best technique tailored for each patient.
- Costs for uninsured patients are approximately $1500 for the surgeon fees, and $2000 for the surgery center fees (including OR time, materials, and recovery) for a total of approximately $3500.
- Some laparoscopic patients experience less pain post-operatively and may be able to return to normal activities sooner (when compared to traditional hernia repair). Laparoscopic hernia surgery can result in better patient experiences for some patients.
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Dr. Harris sees patients from all over Southern California, the greater US, and Canada. Our Newport Beach office is conveniently located in Central Orange county adjacent to John Wayne Airport between the 405, 73, and 55 highways.
Our office staff are experienced in verifying insurance coverage for each patient, as well as offering excellent pricing for patients without insurance (see costs above). We are happy to discuss all forms of payments with patients as needed.