Complex hernias are hernias that recur after surgical repair, or even after multiple repairs. A hernia occurs when tissue or part of an organ protrudes through the abdominal wall. During surgical repair, the abdominal wall is reinforced at its weak point to prevent recurrence of the problem.
Because scar tissue develops at the repair site, however, if the area reherniates, each successive surgery becomes more difficult and is less likely to be successful. Complex hernias may also be associated with further complications, including infections, bowel perforations, or fistulas, where an abnormal attachment is formed between two organs.
Reasons for Complex Hernias
Complex hernias may be caused by inadequate surgical repair of the original hernia or may result from the same events that caused the original hernia, such as:
- Strenuous exercise
- Increased pressure within the abdomen due to accumulation of fluid
- Straining during bowel movements or urination
- Heavy lifting
- Pregnancy
- Excessive weight gain
- Chronic coughing or sneezing
- Abdominal injury or post-surgical complications
Types of Complex Hernias
Unfortunately, any type of hernia may recur. Types of hernia include:
- Abdominal hernia
- Pelvic hernia
- Inguinal hernia
- Incisional hernia
- Hiatal hernia
- Umbilical hernia
Complex Hernia Repair
Complex hernias require surgical repair. Since hernias repaired by pulling tissue together and suturing it have a greater rate of recurrence than those repaired using surgical mesh, repair of complex multiple recurrent hernias usually utilizes the latter technique. Modern tension-free mesh repair generally results in a better surgical outcome. Sometimes a biologic mesh graft, created from human or animal sources, may be used because it offers resistance to infections.
Surgical hernia repairs may be done with open surgery or laparoscopically. Where laparoscopic surgery is possible, it is a much less invasive procedure, requiring smaller incisions and resulting in less pain, less scarring, and a shorter recovery period.
Risks of Complex Hernias
Hernias, particularly when they have recurred, do not resolve on their own. In fact, they tend to grow larger and more problematic over time, causing more swelling and pain. There is also the danger that an untreated hernia may incarcerate, where tissue becomes trapped in the hernia, or strangulate, in which case blood flow to organs is impeded. Either of these situations is a medical emergency.
