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Recurrent hernias are not uncommon. Hernia once repaired properly should not lead to recurrence. There are various reasons whey recurrences happen. The recurrence risk of laparoscopic hernia repair is much less when compared to open hernia repair. The incidence of recurrence is around 10 percent or less based on various literature that is available. Here we present a unique case to discuss of recurrence seen within a mesh in a previously laparoscopic hernia repair with mesh.
Recurrent hernia is usually a surgeons night mare. Especially when all precautions were taken either technical or surgery selection , some patients will present with recurrence. It is a difficult and a challenging problem to diagnose and also to treat. It can also be debilitating to the patient as this may mean that the patient will need another surgery via laparoscopic or open approach. There are reasons for recurrence . A middle aged female who underwent previous hernia repair with mesh presented to our surgeons at MH Surgery Clinic with persistent pain at the hernia area since two months after surgery. She was morbidly obese and had undergone a laparoscopic incisional hernia repair with mesh two years back.
During her evaluation she underwent computed tomography which confirmed that there was a lump superior to the mesh and this was read as possible seroma or hematoma. She was carefully evaluated by our surgeons. All here prior investigations and the current investigations was reviewed. She was diagnosed with recurrence after careful and close evaluation of the investigations by MH Surgery Clinic Surgeons. There was a break in the mesh which was not there in the prior investigations. this was a unique situation with a recurrence within a mesh. She was offered surgery.
During the surgery, we found a recurrence within a break in the prior mesh. This was causing on and off pain as the omentum was getting strangulated and there was incarceration. The hernia was reduced the prior mesh was removed. This was technically a challenging surgery. All this was performed via a Minimally Invasive Advanced Surgery technique by our surgeons who are trained in the type of surgery at the Advanced Hernia Center. The patient underwent a complex procedure called eTEP technique. The patient recovered extremely well and remained with significant low pain and was discharged home.
Recurrent hernias is both debilitating to the patient and to the surgeon. Proper evaluation of patient factors and review of all investigations prior to surgery and post surgery is key in identifying the cause of recurrence. The incidence is usually around 10 percent population. Incorrect mesh choice, improperly placed mesh, technical challenges during surgery , surgeons ability to perform these surgeries and patient factors play a role in recurrences. Most of recurrences will need surgery. It is imperative that such complex situation are dealt by surgeons who are well trained to handle such situations. Our Advanced Hernia Center is one such center where we can handle such complex situation laparoscopically.