Why do Hernia Repairs Fail? | Dr Parthasarathy

Tune in as #DrParthasarathy explains why hernia repairs fail.

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Outline :
0:00 to 0:25 - Why Hernia Repairs Fail?
0:26 to 2:14 - Patient Related Factors
2:15 to 3:42 - Technical Factors
3:43 to 4:20 - What makes hernia repair sustain?

0:00 to 0:25 - Why Hernia Repairs Fail?

Hello everyone. In this video series on failed or recurrent hernias, let us see the next topic. Why do hernia repairs fail? What are the reasons behind it? Broadly, we can divide the reason why a hernia repair fails into two categories. One is patient related factors and second technical factors.

0:26 to 2:14 - Patient Related Factors

So what are the factors which are led to the patient’s condition which makes a chance of a hernia repair to fail in the future? The quality of the patient’s muscle tissue or the scar tissue is very important for a hernia repair to be robust and succeed.

So patients who have DIABETES, uncontrolled diabetes especially have a poor quality of tissue which can cause the hernia repairs to fail in the future.
SMOKERS, they have a poor quality of scar tissue. Their collagen is of inferior quality and a patient who continues to smoke following a hernia repair have a high risk of the repair failing in the future.

OBESITY, like we all know with increase in the size of the abdomen. The abdominal wall also gets stretched, so there is a constant stretching and strain on the previous hernia repair and if the patient gains a lot of weight following a hernia repair the chance of the repair failing is very high.

Similarly a patient who gets PREGNANT very soon following a hernia repair. Generally we advise at least wait for two years following a hernia repair before one gets pregnant. But if the lady gets pregnant too quickly after a hernia repair that can lead to stretching of the tissue before a full healing or integration of the scar has happened and that can cause the hernia repair to fail.

Patients who have extreme SEVERE COUGH because of various lung conditions or allergic conditions following a hernia repair can have a recurrence.

Patients who resume heavy weight lifting very early following a hernia repair can weaken the scar and cause a hernia to come back in the future.
So these are the patient related factors which increase the chance of a well performed hernia repair to fail in the future.

2:15 to 3:42 - Technical Factors

Next coming to the technical factors which affect the repair. By technical factor we mean how was the repair done. So there are so many things one has to consider while doing a hernia repair.

What sort of surgery was done? laparoscopic or open. Neither of this is superior to the other. For the right hernia, a right procedure is always suited. There are some hernias which are best managed by open surgery and if one does a laparoscopic repair for it, the chance of success decreases and vice versa.

Was there a mesh used for hernia repair or not? Like we all know use of a mesh decreases the chance of a hernia to come back in the future and when hernias repaired without a mesh the chance of recurrence is higher.
If a mesh was used what sort of mesh was used. There are so many types of meshes. There are synthetic meshes. There are biologic meshes. There are composite meshes, non-absorbable meshes, heavy weight meshes, and low weight meshes.

There are so many types, which only says that each hernia deserves a specific and correct type of a mesh for it. So if the match between the mesh and the hernia is not perfect that mesh is not going to work for that hernia and the chance of recurrence is higher. Then comes technical factors of how the surgery was performed that also has a very important bearing on the success of hernia.

3:43 to 4:20 - What makes hernia repair sustain?

So generally a hernia succeeding or a hernia recurring is an interplay of all this patient and technical related factors which finally decide the outcome.
A good match of a good quality tissue with well performed repair usually makes a hernia repair sustain permanently

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