A 45-year-old man has a recurrent right inguinal hernia following a previous Lichtenstein repair 5 years ago. The hernia recurred medially at the pubic tubercle. The HERQL-Q and EuraHS studies demonstrate that for recurrent inguinal hernia after previous anterior repair, the recommended approach is:

• A Laparoscopic repair (TAPP or TEP) via a posterior preperitoneal approach ✓
• B Repeat Lichtenstein repair using heavy-weight polypropylene mesh
• C Shouldice repair (tissue repair) to avoid mesh infection risk
• D Bassini repair as the definitive technique for recurrence

Explanation

For recurrent inguinal hernia after a previous anterior repair (Lichtenstein, Bassini, etc.), the EHS (European Hernia Society) and HerniaSurge guidelines strongly recommend a posterior preperitoneal approach (laparoscopic TAPP or TEP) as it accesses virgin tissue planes away from scar tissue from the prior anterior repair, reduces nerve injury risk, and achieves superior outcomes. Repeating the anterior approach through scarred tissue increases complications. EuraHS and HerniQoL data confirm better QoL outcomes with laparoscopic posterior repair for recurrences.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.