Recurrent Inguinal Hernia Repair

Recurrence after inguinal hernia repair is a source of significant morbidity for patients and a significant surgical challenge. Several factors can increase the risk of inguinal hernia recurrence, including smoking, prior recurrence, prior tissue repair, postoperative complications, and low hospital hernia volume. In addition, evidence suggests that hernia formation is linked to systemic connective tissue disease, which may play a role in hernia recurrence. Type of mesh fixation and postoperative activity restrictions, however, do not appear to affect hernia recurrence. When approaching the recurrent hernia, the patient’s symptomatology, functional status, and prior repair type should be considered. Where the diagnosis is unclear, ultrasound is a good initial test, and the surgeon should keep the possibility of femoral hernia in mind. The optimal approach for recurrent repair is a matter of some debate. Generally, laparoscopic repair for recurrent hernia results in less pain and shorter return to full activity. However, evidence suggests that anterior repair is preferred after prior laparoscopic repair, and laparoscopic repair is preferred after prior open anterior repair. This recommendation allows the surgeon to avoid prior scar tissue and avoid complications. Nonetheless, these conventions continue to be challenged by surgeons experienced in certain techniques, and case series show good results with many different methods of repair.