Management of Hernia Surgery Failure

Introduction:

Hernia occurs when the muscle is weakened, and the part of the organ contained by it is bulged out, which occurs due to heavy pressure in the abdomen, such as heavy lifting or straining for bowel movements. It causes pain and discomfort. Treatment for these includes open surgical repair or using a laparoscopy. Failure of hernia surgery includes chronic pain, chronic hematoma, mesh failure, and hernia recurrence.

What Is Hernia?

Hernia is a condition when a part of the organ is bulged out of its place because of weakened muscle and tissue which contains it.

What Are the Types of Hernia?

Common types of hernia are:

1) Inguinal Hernias: The bulge occurs in the groin area when the intestine bulges through two inguinal canals. Men are more affected.

2) Femoral Hernias: The bulge is in the upper thigh, below the groin, which occurs in the femoral canals. Women are more affected.

3) Ventral Hernias: This includes -

• Epigastric hernias: These occur in the upper part of the belly button.
• Incisional hernias: This occurs through the previous abdominal surgical scar.
• Umbilical hernias: These occur around the umbilical cord.

4) Hiatal Hernias: The bulge occurs through the opening called a hiatus in the diaphragm, and a part of the upper stomach is pushed into the chest cavity.

What Are the Causes of Hernia?

The causes of hernia include:

• Familial history of hernia.

• Causing pressure in the belly due to heavy lifting or straining.

• Obese.

• Chronic constipation.

• Chronic coughing.

• Difficulty in urinating.

• Enlarged prostate.

• Peritoneal dialysis.

• Smoking.

• Undescended testicles.

• Ascites (a condition where there is fluid accumulation in the abdomen).

• Poor nutrition.

What Are the Symptoms of Hernia?

The symptoms of a hernia are:

• Noticeable bulge.

• Pain and discomfort near the area.

• Not able to pass gas.

• Symptoms worsen while lifting heavy objects, standing, or straining.

• Hiatal hernias may cause heartburn, regurgitation of food, and acid reflux.

• Strangulation of a hernia occurs when it gets stuck in the hole, it loses its blood supply, which causes severe pain and swelling.

• Nausea and vomiting.

What Are the Surgical Treatments of Hernia?

In a surgical procedure, the weakened abdominal muscle is repaired, and holes are closed. Most hernias require surgical treatment, which includes:

• Open Hernia Surgery: In this procedure, an incision is made near the hernia, and the weakened muscle is repaired. Surgical mesh can also be used to support weak muscles. When sutures are used without mesh, it is called primary closure, which is done in the case of small hernias, strangulated hernias, and inguinal hernias in the case of infants.

• Laparoscopic Hernia Surgery: Several small incisions are made instead of large incisions, which use a device that has a video camera and can be monitored on the screen. Advantages of laparoscopy include decreased scarring, excellent visualization, extended reach, and a faster healing rate.

What Is the Management of Hernia Surgery Failure?

The failures of hernia surgery include:

1. Hernia Mesh Failure: It can occur due to:

• Failure of mesh material includes being heavy, small, shrinkage, breakage, migration, or rejection by the body’s immune system.

• The patient’s health condition includes anemia, impaired blood clotting, malnutrition, obesity, smoking, diabetes, and undergoing chemotherapy.

• Open surgical techniques are more prone to hernia recurrence.

Symptoms such as pain from the scar tissue, nerve injury infection, bowel obstruction due to scar tissue, and hernia recurrence can occur.

Management includes making mesh diagnoses using an X-ray, MRI (magnetic resonance imaging), or CT (computed tomography) scan. In case of infection, antibiotics are given, and in case of failed surgical mesh, it has to be removed, and a revised surgical procedure should be done.

2. Chronic Pain: It is a common problem in the case of inguinal hernia repair, which lasts for at least six months. It can be a nerve pain or pain due to damage around surrounding tissue; it occurs due to:

• Mesh weight.

• Type of fixation method.

• Injury to the nerve.

• Nerves trapped in meshoma (mesh which is shrunken and rolled into a ball).

• Inflammation around the mesh.

• Recurrence of hernia.

Management of chronic pain includes the use of analgesics (nonsteroidal anti-inflammatory drugs, tricyclic antidepressants, or gabapentinoids) which is the first-line treatment, anesthetic blocks at the site of pain, blocking nerve by using radiofrequency heating and surgical intervention of removing mesh and neurectomy (a surgical procedure to remove the nerve).

3. Hematoma: It is an early complication after hernia repair, or it can be chronic for more than six months. It can occur due to the following:

• Chronic anticoagulation.

• Recurrence of the hernia.

• Larger hernia defect.

• Defect in mesh fixation.

• Use of nonabsorbable mesh.

Chronic hematoma can cause pressure and pain around the area and become a solid tumor. Management of chronic hematoma includes surgical removal.

4. Recurrence of Hernia: When a part of the organ is bulged out of its place even after the hernia repair, it is referred to as a recurrence of the hernia.

The risk factors for the recurrence of hernia are:

• Obesity.

• Diabetes mellitus type 2.

• Smoking.

• Steroid or chemotherapy treatment.

• Causing pressure in the belly due to heavy lifting or straining soon after the initial surgery.

• Chronic lung disease.

• Chronic cough.

• Infection of the previous wound.

• Failure of mesh material includes being heavy, small, shrinkage, breakage, and migration.

• Tension on the sutured line.

The symptoms of a recurrent hernia are:

• Noticeable bulge.

• Pain can be dull or severe.

• Constipation.

• Bloating.

The management of recurrent hernia includes using analgesics for pain, and surgical treatment such as tension-free repair should be implied. Different types of surgical treatment are:

• Laparoscopic hernia repair: It uses a device with a video camera, and it is a minimally invasive procedure. A mesh is used to repair the recurrent hernia.

• Open hernia repair: An incision is given, and the building organ is pushed back; a mesh is used and is sutured.

• Robotic hernia repair: This technique uses robotic-assisted technology.

Conclusion:

Hernia is a painful disorder that needs surgical repair. Even after the repair, the patient may have chronic pain, or the hernia can occur due to mesh failure and if the patient has risk factors such as being obese, undergoing steroid, chemotherapy, or infection. Such cases require revised surgical treatment, and preventive measures should be taken to avoid the recurrence of the hernia.