What is the recurrence rate following open inguinal hernia repair?

Updated: Jan 17, 2018
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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The recurrence rate for Lichtenstein hernioplasty at specialist clinics in the United States is consistently less than 1%. In an audit of Lichtenstein hernioplasty performed with local anesthesia by surgical residents, the recurrence rate was 2.1% over a 10-year follow-up period.

Recurrence in Lichtenstein hernioplasty may be due to inaccurate execution of the technique (inadequate size or improper fixation of the mesh) or to an overlooked hernia at the primary operation. To avoid the latter, the patient should be asked to cough, and the region should be carefully examined for an indirect hernia, a direct hernia, a femoral hernia, or a combined hernia.

Recurrence may be more frequent in the presence of comorbid conditions (eg, chronic obstructive pulmonary disease) or obesity or with the use of steroids. Other contributing factors may be the use of too-small pieces of mesh placed flat under tension, failure to achieve adequate overlap (medially, 2 cm beyond the pubic tubercle; laterally, 5-6 cm beyond the internal ring), or failure to cross the tails of the mesh. A thorough clinical evaluation, a high degree of suspicion, and diligent follow-up are advised to keep track of recurrences.

Women, because of the higher frequency of femoral hernias, are at greater risk for recurrence (inguinal or femoral) after an open inguinal hernia operation than men are. In female patients, the existence of a femoral hernia should always be excluded by exposing the femoral canal. [5]

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