ZenToks Publication

Chapter 25

Recurrent Inguinal Hernia in Adults: A Review

Abstract/Preface

Recurrent inguinal hernia continues to pose a substantial clinical challenge despite advancements in hernia surgery. The recurrence rate following primary inguinal hernia repair varies between 1% and 15%, influenced by patient-related factors, surgical technique, mesh use, and follow-up duration. It is crucial for surgeons engaged in abdominal wall reconstruction to comprehend the factors associated with recurrence and to identify optimal management strategies. Numerous risk factors have been associated with hernia recurrence. Patient-related factors include advanced age, obesity, smoking, diabetes mellitus, malnutrition, collagen disorders, chronic cough, constipation, and activities that increase intra-abdominal pressure. Surgical factors such as inadequate dissection, improper mesh placement or fixation, tension on the repair, infection, and surgeon inexperience also significantly contribute to recurrence. The management of recurrent inguinal hernia requires a tailored approach based on the index repair. For recurrences following an anterior repair, a posterior laparoscopic approach, such as transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP) repair, is generally preferred. In contrast, recurrent hernias after a posterior repair are typically managed with an open anterior mesh repair. This chapter synthesizes current evidence on the incidence, risk factors, and contemporary management of recurrent inguinal hernia in adults.