INTRODUCTION

The recurrence rate of an inguinal hernia following a primary herniorrhaphy or hernioplasty ranges from 0.5 to 15 percent, depending upon the type of repair and duration of follow-up [1-3]. The operative management of a recurrent inguinal hernia is a more significant undertaking than an initial inguinal hernia repair, and recurrence rates approach 20 percent [2,4-6]. To ensure optimal outcomes, surgeons must understand the anatomy, causes of recurrence, and the prior surgical repair technique(s) performed, and then individualize treatment based upon these factors (figure 1 and figure 2 and figure 3).

The operative management of recurrent inguinal hernias will be reviewed here. Overviews for the treatment of inguinal hernias in adults and children, and open and laparoscopic techniques for inguinal hernia repairs are discussed elsewhere. (See "Overview of treatment for inguinal and femoral hernias" and "Overview of inguinal hernia in children" and "Inguinal and femoral hernia repair: Open techniques" and "Inguinal and femoral hernia repair: Laparoscopic techniques".)

RISK FACTORS FOR RECURRENT HERNIA

Risk factors associated with an increased risk of recurrence following a hernia repair include patient related factors, technical factors, and surgical skills. In addition, any factor that impairs wound healing may contribute to the development of a recurrent hernia.

Patient-related factors — Clinical characteristics of patients at an increased risk of recurrent hernias following a repair include [7,8]:

• Smoking
• Older age at initial hernia presentation
• Arteriosclerosis
• Diabetes mellitus
• Metabolic disorders including obesity and renal insufficiency
• Deficiency of coagulation factor VIII or vitamin C
• Steroids and chemotherapeutic agents
• Increased intra-abdominal pressure caused by postoperative chronic cough, constipation, and bowel distention