COLLECTIVE REVIEWS Management of Recurrent Inguinal Hernias

The ultimate measure of success of inguinal hernia repair is the rate of recurrence. Although other procedure-related complications are important and have been shown to affect healthrelated quality-of-life parameters, recurrence is more challenging for the patients and the surgeon. From the patients’ perspective, the initial physical and mental investment in the operation has failed. A new investment has to be made, with fewer guarantees for success, more risks for more serious complications, and more time off from work. For the surgeon, repair of a recurrent inguinal hernia is technically more demanding because scar tissue causes the inguinal canal to be obscured and distorted. In addition, the tissue tends to be weaker than at the time of primary repair, resulting in a substantially higher risk for complications or development of another recurrence. Although much has been published about primary repair of inguinal hernias, less is known about the best approach to address a recurrent hernia. In this review, we address the “pros and cons” of popular surgical approaches and watchful waiting for recurrent inguinal hernias and indications for each. In the absence of best evidence in this field, the authors present an opinion based on their experience and a review of the available literature primarily extracted from large trials and large cohorts for inguinal hernia repair in general.