From the Guidelines
Surgical repair using a mesh-based technique is the recommended treatment for a recurrent inguinal hernia, with laparoscopic approaches being preferred for most patients. The use of mesh in clean surgical fields is associated with a lower recurrence rate, without an increase in the wound infection rate, as stated in the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.
Key Considerations
- Laparoscopic approaches, such as transabdominal preperitoneal repair or totally extraperitoneal repair, are preferred for recurrent hernias because they allow the surgeon to operate through tissue not previously dissected, reducing complications 1.
- Open anterior mesh repair with the Lichtenstein technique is an alternative when laparoscopic surgery isn't feasible.
- The procedure usually takes 45-90 minutes and is often performed as outpatient surgery.
- Patients typically require 1-2 weeks of recovery before returning to normal activities, with avoidance of heavy lifting (over 10-15 pounds) for 4-6 weeks.
- Pain management includes acetaminophen and NSAIDs, with limited opioids for severe pain.
Recurrence and Complications
- Recurrent hernias have higher surgical complexity and slightly higher re-recurrence rates (10-15%) compared to primary repairs (1-5%) 1.
- Watchful waiting is generally not recommended for recurrent hernias due to increased risk of complications like incarceration or strangulation.
- Diagnostic laparoscopy may be a useful tool for assessing bowel viability after spontaneous reduction of strangulated groin hernias, with a grade 2B recommendation 1.
Mesh Repair
- The use of mesh in clean surgical fields (CDC wound class I) is associated with a lower recurrence rate, if compared to tissue repair, without an increase in the wound infection rate, as stated in the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.
- For patients having complicated hernia with intestinal strangulation and/or concomitant need of bowel resection without gross enteric spillage (clean-contaminated surgical field, CDC wound class II), emergent prosthetic repair with synthetic mesh can be performed, with a significant lower risk of recurrence, regardless of the size of hernia defect 1.
From the Research
Recurrence of Inguinal Hernia Treatment
The recommended treatment for a recurrence of inguinal hernia includes:
- Laparoscopic repair, which offers significant advantages over open techniques in terms of recurrence risk, pain, and recovery, especially for patients with recurrent inguinal hernia, bilateral inguinal hernia, or women 2
- Total extraperitoneal (TEP) repair, which has been shown to have a lower re-recurrence rate than open repair during long-term follow-up evaluation 3
- Transabdominal preperitoneal (TAPP) repair, which is also an acceptable method for the repair of recurrent inguinal hernia 3
Comparison of Open and Laparoscopic Repair
A study comparing open and laparoscopic repair of recurrent inguinal hernias found that:
- There was no statistical difference in the re-recurrence rate between the two techniques during short-term follow-up evaluation 3
- The laparoscopic technique had a significantly lower re-recurrence rate than the open technique during long-term follow-up evaluation 3
- Both procedures were comparable in terms of intra- and postoperative complications 3
Hybrid Method for Obstructed Recurrent Inguinal Hernia
A case report described a hybrid method using TEP and mesh plug repair for the management of an obstructed recurrent inguinal hernia, which resulted in no perioperative complications or hernia recurrence 4
Long-term Follow-up of TEP Repair
A cohort study with a mean follow-up period of 13 years found that:
- The overall recurrence rate after TEP repair was 8.9% 5
- No predicting factor for recurrent hernia could be identified 5
- The percentage of bilateral hernias was higher than previously known, highlighting the importance of examining the contralateral side 5
Mesh Fixation in Laparoscopic Repair
A study on mesh displacement after bilateral inguinal hernia repair with no fixation found that: