Click here for the--> HERNIA Home Page
 
 
'Recurrent',
'Incisional'
and
Other Complex Hernias

Click here to SKIP Recurrent, Incisional and Other complex Hernias
 
 
 

Why is the whole subject of hernia RECURRENCE
so important ?
"A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease"
Sir Cecil Wakely
President: Royal College of Surgeons (Eng) 1948
The hernia repair performed at this Centre enables us to be confident against recurrence 'for life'. Unfortunately, however, repairs performed elsewhere are not this reliable and failures can and, all too often, do occur at any time in the patient's lifetime.
 

When a hernia repair operation breaks down (i.e. a 'recurrent' hernia) further repair operations are more difficult than the first and, to make matters worse, the chances of success actually diminish with each successive attempt at repair.

 The same is true of the breakdown of the scar in the abdominal wall from an incision for a previous operation for some other problem. This is called an 'incisional' hernia. Thus the 'recurrent' hernia and the 'incisional' hernia are very similar in many respects, including the difficulties in effecting a reliable repair.

Unfortunately, there are also cases of 'multiple hernias' and of combinations of all the above, such as 'multiple, RECURRENT hernias'. These cases pose many difficulties to most surgeons and are, all too often, not successfully repaired.
Perhaps this is why Sir Cecil made the above historical statement on the subject of recurrences!

 
 

Difficulties With The Generally-Used Method
Not only are the tissues in the abdominal wall more scarred and therefore potentially harder to work on, but recurrent repair operations suffer a significant failure rate.

 Subsequent repairs of recurrent hernias by the usual anterior (front) approach are followed by further recurrence in 20% and more of cases over the years. In some cases this is a serious hazard and multiple recurrences fare even worse, even exceeding a 50% chance of failure! (See below)

 The 'front' approach of recurrent hernia repair carries the further risk in the case of a male patient of damage to the blood supply to the testicle when cutting through scar tissue in that area, which can lead to a patient losing a testicle as a result.

 Because of this, together with the fact that the common approach is followed by an increasing incidence of recurrence, we prefer an entirely different and better method of repair in which we specialise.


The British Hernia Centre Method
Our operation is performed via an incision higher than the previous one(s) and the hernia itself is approached from behind the weakness in the abdominal muscles. There is, therefore, no need to cut through scar tissue and the described risks to the testis do not apply.

The hernia opening is then completely covered by a mesh 'veil' applied from the inside, making it virtually impossible for a further recurrence to take place. In effect, the whole area of abdominal wall surrounding the hernia site(s) becomes reinforced without really involving the area(s) previously operated upon.
 

Is recovery much slower?

Because our technique avoids the usual, high levels of tissue trauma and the repair is 'tension-free' (in the same way as is described earlier for the less complex repairs), there is surprisingly little discomfort and recuperation is just as rapid as after our 'simpler' hernia repairs.

 Patients are expected to be as active as possible from the first day i.e. walking 1 to 2 miles, swinging a golf club (or similar activity) and return to completely normal routine, work etcetera, often in 4 to 7 days.

What of REALLY complex cases?

Depending on how complex the case, we can still perform some recurrent hernia repairs under local anaesthesia, although the more problematic and most complex cases are performed by this particular procedure with the help of just a light, general anaesthetic.

 Factors that decide the approach include how long the patient has left the hernia untreated, how many times it has already been repaired, how large it is and so on.

In the vast majority of cases, even the more complex ones, the patient still leaves the same day and is 'dressed for dinner' that same evening. Only in the most challenging of cases is there a need for overnight hospital stay, and even then normally for only one night. A prior examination will determine which is the most suitable course for each case.

We have a technique perfectly suited to each individual case and in which we have gained unique experience. The extremely large number of hernia cases seen each year at The British Hernia Centre, added to the experience of thousands of cases we have already performed, puts us in a singular position to offer this superior technique of repair for the more complex cases. 


Instead of the recurrence rates previously deemed the 'norm', of
20 to 50 % or more,
a recent study* of cases performed at The British Hernia Centre has shown a recurrence rate with our repair of recurrent hernias (including complex, multi-recurrent cases) of LESS THAN 1%
For the first time, the success rate for MULTI-RECURRENT hernias
is as low as for PRIMARY (first-time) hernias!

* See 'Academic References' later in this site
The British Hernia Centre is the first British group to have published results of this procedure.

NEXT
Stoma Hernias
Hernia HOME PAGE