“To Revise or Not Revise…”

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May 30, 2019

The Pros & Cons of Hernia Mesh Revision Surgery: When is Revision Surgery Right for Me?

Choosing whether or not to have revision surgery after a hernia recurs is a big decision, and one that should be made with the help of your doctor.

Hernias have a high rate of recurrence. Depending on the type and size of the hernia, as well as the surgical technique used, the recurrence rate is anywhere from 2% to 30%, and that rate is even higher for recurrent hernias, according to studies.

Hernia repairs are one of the most commonly performed general surgeries, with more than one million performed in the United States each year.

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20%
Some estimate that hernia mesh patients have an 85% likelihood of having a second revision surgery in their lifetime.

There is always a risk of a hernia recurring, but the use of surgical mesh in repairs helps to decrease that risk. Unfortunately, many problematic meshes were approved by the U.S. Food and Drug Administration (FDA) and entered the market in the early to mid-2000s, putting millions of people at risk for complications.

Most of these problem meshes were recalled several years later, but it was too late for those people who were implanted with faulty meshes.

Even people who underwent surgery without the use of a problem mesh are at risk for recurrence and other complications down the road. A long-term study published online by JAMA in 2016 showed the risks of mesh may outweigh the benefits for some patients who underwent surgery for incisional hernia repair.

The study authors noted that mesh implantation prevented the need for subsequent reoperation in relatively few patients, meaning most patients who underwent hernia surgery repair eventually had their hernia recur. The authors also noted that the benefits associated with mesh are sometimes offset by long-term complications, such as bowel obstruction, bowel perforation, bleeding, and abscess. These complications seemed to progress increasingly over time.

How do you know if revision surgery is right for you? It depends on a number of factors, including your own quality of life and whether the benefits outweigh the risks for you. It can also depend on the type of hernia you experienced and the size. You should discuss with your doctor the pros and cons of revision surgery.

The Pros

Revision surgery can increase your quality of life, including your emotional and social well-being. If your hernia prevented you from going to work, meeting with friends or family, or enjoying your most treasured activities, this is a decrease in your quality of life. Having revision surgery may turn those things around for you.

A long-term study published in the Annals of the Royal College of Surgeons of England in 2015 found that surgical intervention significantly improved patients’ quality of life, even when revision was necessary.

Revision surgery can prevent future complications. Even if your hernia is small, it may get bigger over time and cause more intense symptoms, like pain, . A rare, but serious complication of a hernia left untreated is strangulation. Strangulation occurs when part of the intestine or fatty tissue is trapped inside the hernia and is cut off from its own blood supply.

Surgery can also relieves any swelling or feeling of heaviness, tugging, or burning in the area of the hernia.

Hernias do not go away on their own, only surgery can repair a hernia. If your symptoms are severe or are affecting your quality of life, you may consider getting revision surgery.

The Cons

The hernia could come back. Just like your first recurrence, a second or third recurrence is also possible. The odds of a hernia recurring again increase with each recurrence.

There are risks inherent in any surgery. These risks include:

  • A bad reaction to the anesthesia
  • Infection and bleeding
  • Nerve damage, numb skin, or loss of blood supply
  • Damage to nearby arteries or veins
  • Damage to the intestines, bladder, or other organs and tissues depending on the location of the hernia

Alternatives to Revision Surgery

Watchful waiting. There is really only one alternative to revision surgery and that is watchful waiting. If your hernia is small or your symptoms are not severe, you may decide not to get revision surgery despite your hernia recurring.

If you choose watchful waiting, your surgeon will watch the hernia to make sure it doesn’t get bigger or cause problems. This is an option for those with smaller hernias or who do not experience symptoms that impact their health or quality of life.

The Bottomline

Hernias are extremely common and can only be repaired surgically. If you don’t experience symptoms or if those symptoms are ones you can live with, you may decide not to get surgery. However, not getting surgery may put you at risk for complications down the road, including the rare but serious complication strangulation.

Even if you do decide to get revision surgery, you’re still at risk for the hernia recurring again. However, surgery can increase your quality of life and may prevent further complications down the road.

You should discuss with your doctor whether revision surgery is right for you.

Sources

Science Direct. “Recurrence after groin hernia repair-revisited,” by Sri Vengadesh Gopal and Achuthan Warrier. Published April 2013. Accessed June 2019: https://www.sciencedirect.com/science/article/pii/S1743919113000873

Kaiser Permanente. “Inguinal Hernia: Should I Have Surgery Now, or Should I Wait?” Revised November 2018. Accessed June 2019: https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=za1162

Annals. “Durability of giant hiatus hernia repair in 455 patients over 20 years,” by PA Le Page, et al. Published April 2015. Accessed June 2019: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4474010/

UCI Health. “Is surgical mesh safe for my hernia surgery?” Published June 2018. Accessed June 2019: https://www.ucihealth.org/blog/2018/06/mesh-hernia-repair

Science Daily. “Study finds mixed results for use of mesh for hernia repair.” Published October 2018. Accessed June 2019: https://www.sciencedaily.com/releases/2016/10/161018094928.htm

FDA. “Hernia Surgical Mesh Implants.” Revised February 2018. Accessed June 2019: https://www.fda.gov/medical-devices/implants-and-prosthetics/hernia-surgical-mesh-implants