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
Kfir Ben-David, MD
- 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 "Overview of 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.
- Bay-Nielsen M, Kehlet H, Strand L, et al. Quality assessment of 26,304 herniorrhaphies in Denmark: a prospective nationwide study. Lancet 2001; 358:1124.
- EU Hernia Trialists Collaboration. Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 2002; 235:322.
- Bay-Nielsen M, Kehlet H. Inguinal herniorrhaphy in women. Hernia 2006; 10:30.
- EU Hernia Trialists Collaboration. Mesh compared with non-mesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000; 87:854.
- Scott NW, McCormack K, Graham P, et al. Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev 2002; :CD002197.
- Dahlstrand U, Wollert S, Nordin P, et al. Emergency femoral hernia repair: a study based on a national register. Ann Surg 2009; 249:672.
- Glassow F. Femoral hernia. Review of 2,105 repairs in a 17 year period. Am J Surg 1985; 150:353.
- Rosenberg J, Bisgaard T, Kehlet H, et al. Danish Hernia Database recommendations for the management of inguinal and femoral hernia in adults. Dan Med Bull 2011; 58:C4243.
- Bisgaard T, Bay-Nielsen M, Kehlet H. Re-recurrence after operation for recurrent inguinal hernia. A nationwide 8-year follow-up study on the role of type of repair. Ann Surg 2008; 247:707.
- Dedemadi G, Sgourakis G, Radtke A, et al. Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes. Am J Surg 2010; 200:291.
- Miserez M, Alexandre JH, Campanelli G, et al. The European hernia society groin hernia classification: simple and easy to remember. Hernia 2007; 11:113.
- Sevonius D, Gunnarsson U, Nordin P, et al. Recurrent groin hernia surgery. Br J Surg 2011; 98:1489.
- Bay-Nielsen M, Nordin P, Nilsson E, et al. Operative findings in recurrent hernia after a Lichtenstein procedure. Am J Surg 2001; 182:134.
- Mikkelsen T, Bay-Nielsen M, Kehlet H. Risk of femoral hernia after inguinal herniorrhaphy. Br J Surg 2002; 89:486.
- Lau H. Recurrence following endoscopic extraperitoneal inguinal hernioplasty. Hernia 2007; 11:415.
- Lo Menzo E, Spector SA, Iglesias A, et al. Management of recurrent inguinal hernias after total extraperitoneal (TEP) herniorrhaphies. J Laparoendosc Adv Surg Tech A 2009; 19:475.
- Zendejas B, Ramirez T, Jones T, et al. Incidence of inguinal hernia repairs in Olmsted County, MN: a population-based study. Ann Surg 2013; 257:520.
- Magnusson N, Nordin P, Hedberg M, et al. The time profile of groin hernia recurrences. Hernia 2010; 14:341.
- Søndenaa K, Nesvik I, Breivik K, Kørner H. Long-term follow-up of 1059 consecutive primary and recurrent inguinal hernias in a teaching hospital. Eur J Surg 2001; 167:125.
- Eklund AS, Montgomery AK, Rasmussen IC, et al. Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 2009; 249:33.
- Matthews RD, Anthony T, Kim LT, et al. Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 2007; 194:611.
- Kingsnorth AN, Britton BJ, Morris PJ. Recurrent inguinal hernia after local anaesthetic repair. Br J Surg 1981; 68:273.
- Nordin P, Haapaniemi S, van der Linden W, Nilsson E. Choice of anesthesia and risk of reoperation for recurrence in groin hernia repair. Ann Surg 2004; 240:187.
- Kehlet H, Bay-Nielsen M. Local anaesthesia as a risk factor for recurrence after groin hernia repair. Hernia 2008; 12:507.
- Rutkow IM. The recurrence rate in hernia surgery. How important is it? Arch Surg 1995; 130:575.
- Jansen PL, Klinge U, Jansen M, Junge K. Risk factors for early recurrence after inguinal hernia repair. BMC Surg 2009; 9:18.
- Abrahamson J. Etiology and pathophysiology of primary and recurrent groin hernia formation. Surg Clin North Am 1998; 78:953.
- Burcharth J, Andresen K, Pommergaard HC, et al. Direct inguinal hernias and anterior surgical approach are risk factors for female inguinal hernia recurrences. Langenbecks Arch Surg 2014; 399:71.
- Koch A, Edwards A, Haapaniemi S, et al. Prospective evaluation of 6895 groin hernia repairs in women. Br J Surg 2005; 92:1553.
- Franz MG. The biology of hernia formation. Surg Clin North Am 2008; 88:1.
- Junge K, Klinge U, Rosch R, et al. Decreased collagen type I/III ratio in patients with recurring hernia after implantation of alloplastic prostheses. Langenbecks Arch Surg 2004; 389:17.
- Zheng H, Si Z, Kasperk R, et al. Recurrent inguinal hernia: disease of the collagen matrix? World J Surg 2002; 26:401.
- Neumayer LA, Gawande AA, Wang J, et al. Proficiency of surgeons in inguinal hernia repair: effect of experience and age. Ann Surg 2005; 242:344.
- Bisgaard T, Bay-Nielsen M, Christensen IJ, Kehlet H. Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair. Br J Surg 2007; 94:1038.
- Fitzgibbons RJ Jr, Giobbie-Hurder A, Gibbs JO, et al. Watchful waiting vs repair of inguinal hernia in minimally symptomatic men: a randomized clinical trial. JAMA 2006; 295:285.
- Rutkow IM. Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 2003; 83:1045.
- Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK. Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia. Br J Surg 2010; 97:4.
- Dedemadi G, Sgourakis G, Karaliotas C, et al. Comparison of laparoscopic and open tension-free repair of recurrent inguinal hernias: a prospective randomized study. Surg Endosc 2006; 20:1099.
- Kouhia ST, Huttunen R, Silvasti SO, et al. Lichtenstein hernioplasty versus totally extraperitoneal laparoscopic hernioplasty in treatment of recurrent inguinal hernia--a prospective randomized trial. Ann Surg 2009; 249:384.
- Beets GL, Dirksen CD, Go PM, et al. Open or laparoscopic preperitoneal mesh repair for recurrent inguinal hernia? A randomized controlled trial. Surg Endosc 1999; 13:323.
- Eklund A, Rudberg C, Leijonmarck CE, et al. Recurrent inguinal hernia: randomized multicenter trial comparing laparoscopic and Lichtenstein repair. Surg Endosc 2007; 21:634.
- Feliu X, Torres G, Viñas X, et al. Preperitoneal repair for recurrent inguinal hernia: laparoscopic and open approach. Hernia 2004; 8:113.
- Alani A, Duffy F, O'Dwyer PJ. Laparoscopic or open preperitoneal repair in the management of recurrent groin hernias. Hernia 2006; 10:156.
- Li J, Ji Z, Li Y. Comparison of laparoscopic versus open procedure in the treatment of recurrent inguinal hernia: a meta-analysis of the results. Am J Surg 2014; 207:602.
- Neumayer L, Giobbie-Hurder A, Jonasson O, et al. Open mesh versus laparoscopic mesh repair of inguinal hernia. N Engl J Med 2004; 350:1819.
- 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
- - 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