Recurrent inguinal and femoral hernia
- George A Sarosi, Jr, MD
George A Sarosi, Jr, MD
- Robert H. Hux Professor
- Department of Surgery
- University of Florida College of Medicine
- Kfir Ben-David, MD, FACS
Kfir Ben-David, MD, FACS
- Vice Chairman of Surgery
- Chief of Gastroesophageal Surgery
- Mount Sinai Medical Center
Recurrence rates for primary hernia repair range from 0.5 to 15 percent depending upon the hernia site (direct, indirect, femoral), type of repair (mesh, no mesh, open, laparoscopic) and clinical circumstances (elective, emergent) [1-5]. Hernia recurrence is less common with repair of inguinal compared with femoral hernia repair due the higher rate of emergency surgery and complications associated with femoral hernia [6,7].
The indications for recurrent inguinal and femoral hernia repair are similar to those of primary inguinal and femoral hernia repair. Most symptomatic patients should undergo repair; however, some minimally symptomatic male patients can be safely observed. The choice of technique for repair of recurrent inguinal hernia is largely anatomically-based, depending upon the nature of the prior hernia repair. In general, failed posterior repairs (eg, laparoscopic) should be repaired using an anterior approach, and vice-versa, failed anterior repairs (eg, Lichtenstein repair) should be repaired using a posterior approach . Repair of recurrent inguinal hernias can be more complicated than primary inguinal hernia repair, and is associated with higher rates of recurrence (ie, re-recurrence) and other complications [9,10].
Recurrent inguinal hernia will be reviewed here. The clinical features, diagnosis, and management of inguinal and femoral hernia in adults and children, and repair techniques (open, laparoscopic) are discussed elsewhere. (See "Overview of treatment for inguinal and femoral hernia in adults" and "Inguinal hernia in children" and "Open surgical repair of inguinal and femoral hernia in adults" and "Laparoscopic inguinal and femoral hernia repair in adults".)
DEFINITIONS AND RECURRENCE SITE
Inguinal and femoral hernias are classified according to their etiology and anatomic site. A primary etiology for hernia is related to congenital tissue abnormalities, whereas a secondary hernia etiology is related to acquired tissue abnormalities (eg, trauma). (See "Classification, clinical features, and diagnosis of inguinal and femoral hernias in adults".)
●Primary hernia repair – A primary hernia repair refers to the initial or index hernia repair. Primary hernia repair should not be confused with repair of a primary hernia (as compared with a secondary hernia), as classified by etiology.
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- DEFINITIONS AND RECURRENCE SITE
- Anatomic site of recurrence
- EPIDEMIOLOGY AND RISK FACTORS FOR RECURRENT INGUINAL HERNIA
- Technical issues
- - Non-mesh hernia repair
- - Inadequate mesh size or fixation
- - Missed cord lipoma
- - Type of anesthesia
- Patient factors
- - Gender
- Surgeon experience
- CLINICAL FEATURES
- Timing of recurrence
- INDICATIONS FOR REPAIR
- PREOPERATIVE PREPARATION
- MESH FOR RECURRENT HERNIA
- APPROACH TO RECURRENT INGUINAL HERNIA REPAIR
- Open versus laparoscopic repair
- Suggested approach
- Re-recurrent hernia
- SUMMARY AND RECOMMENDATIONS