Hernia is defect in the abdominal wall muscle. This can be at the site of the umbilicus or the groin area which are some of the natural exit points of human body. The intrabdominal contents will protrude out through these defects and can sometimes become trapped and strangulated. The other reasons to develop a hernia are previous surgery or trauma.

Recurrent hernia is one in which an attempt has been made to repair this hernia initially. But despite that the defect has come again with the herniation of intraabdominal contents. The reasons for the recurrence of a hernia are:

1.infection of the wound after the initial surgery

2. excessive exertion too soon after the surgery

3. chronic use of steroids/ other medications

4. chronic acute cough

5. smoking

6. obesity

7. improper technique or missed hernia defects

Concerns or Complications of recurrent hernia

The plane of dissection of the muscles has been breached. There may be a mesh or stitches which are placed at the time of the initial surgery, these may cause adhesions with the bowel or the intestine. The hernia defects may be more painful. There may be missed hernial defects. There may be some additional involvement of the nerves or exaggerated muscle weakness.

The repair of such recurrent or complex hernia requires a tailor-made treatment. They need proper investigations, mostly by a CT scan of the abdomen to understand the anatomy of the area. The size of the defect, the volume of the herniated contents, the intent of repositioning all needs to be incorporated in making a strategy for the surgical repair.

The patient must be prepared prior to the surgery. Any medical conditions which may have predisposed to the formation of the recurrent hernia have to be optimized and corrected. The surgical technique must be formulated as per the individual needs and the consumables must be arranged which may be customized to the case. Astute attention is placed in the intraoperative steps to avoid inadvertent complications of bleeding and bowel injury. Ergonomic placement of the mesh over a tension free approximation of the hernia defect is the corner stone of a successful repair. Aesthetic closure of the skin and the subcutaneous tissue enhances the overall appearance.

The team of surgeon, radiologist, plastic surgeon, nutritionist and an internist are involved in the overall management of the patient.