How to avoid recurrence of inguinal hernia? How is a recurrent inguinal hernia treated? Recurrent inguinal hernias are very common in clinical practice. We often deal with recurrent inguinal hernias in our clinical work. Some patients have undergone 2-3 surgeries in outside hospitals and have recurred after each surgery, and even more patients have received sclerotherapy injections in outside hospitals, resulting in increased surgical difficulty and risk after another recurrence, causing challenges for the surgeon and pain for the patient himself. Thus, it is particularly important to pay attention to the treatment of recurrent hernias. The rate of recurrence after inguinal hernia surgery ranges from 1-10%, depending on the type of hernia of the patient, the surgeon’s choice of surgical approach and the surgical technique. Therefore, it is very important that the first surgery is performed correctly. Even if an experienced surgeon performs the surgery, there is still a certain rate of recurrence. The prevention of hernia recurrence is something that every surgeon should take into account. How to prevent recurrence? 1. Strictly grasp the indications for surgery: In addition to the local anatomical defects in the inguinal region, the factor of increased abdominal pressure is also an important cause of recurrence in the occurrence of inguinal hernia. Therefore, the comorbidities need to be treated accordingly during the treatment of hernia surgery. 2. careful exploration during surgery: the purpose of intraoperative exploration: ① to confirm the preoperative diagnosis; ② to assess the degree of abdominal wall weakness and defect and to decide on the surgical approach; ③ to exclude the possibility of the presence of an associated hernia. 3. Standardize surgical operation: fully recognize that each patient’s inguinal hernia is different, adopt individualized treatment means and standardize the operation. 4. Appropriate selection of surgical style: The surgical mode of primary external ventral hernia should in principle be determined according to the patient’s age, the cause of morbidity (congenital or acquired, with or without predisposing factors), and the degree and extent of local tissue defects, and therefore should generally be decided after assessment of the tissues surrounding the hernia during surgery. Regardless of the surgical approach, a tension-free repair is an important requirement for successful surgery. In recent years, the introduction of tension-free hernia repair has greatly reduced the recurrence rate of extra-abdominal hernias. Causes of recurrence after inguinal hernia repair: 1. Etiological classification According to the process of recurrent hernia, it can be clinically classified into 2 categories: (1) true recurrent hernia: it refers to the recurrence of hernia at the site of the initial hernia surgery. The recurrent hernia is the same as the initial hernia in terms of anatomic site and type of hernia. This recurrent hernia is partly related to the unsatisfactory first surgery. (2) Pseudo-recurring hernia: contains 2 conditions: ① Legacy hernia: a hernia that was not detected during the initial hernia repair surgery, resulting in a postoperative residual and recurrence. (2) New hernia: The initial surgery was successful, but a new hernia occurred again. The above three cases are not exactly the same, and the analysis and treatment should be different. However, in clinical practice, it is difficult to distinguish the types of recurrent hernias because they belong to re-operation, the surgical does are high, and the tissue structure is complex. Surgical modality of recurrent hernia: The specific treatment modality of recurrent hernia varies according to the patient’s age, physical condition, the way of the original surgery, and the type of recurrence. In general, tension-free repair is predominant, i.e., patch application for repair. Among them, minimally invasive laparoscopic surgery occupies a more important place. Thus, the principles of surgery for recurrent inguinal hernia are the same as for general hernia surgery, with multiple procedures to choose from. Currently, the tension-free hernia repair technique has become the preferred method for surgical treatment of inguinal hernias, and laparoscopic tension-free hernia repair surgery is a safe and effective means for the treatment of recurrent inguinal hernias and deserves to be promoted. Why laparoscopic surgery is advantageous in recurrent hernias: The diagnosis of recurrent inguinal hernia is not difficult, but it is sometimes difficult to determine the type and anatomical site of recurrent hernia preoperatively. In reoperation by the traditional anterior approach, it is sometimes not easy to distinguish the type of recurrent hernia due to the separation and scar formation of the previous surgery and the different degrees of local anatomical levels. The difficulty in differentiation brings about blindness in treatment leading to recurrence after surgery. Since laparoscopy allows direct observation of the location, size, and relationship of the recurrent hernia to the site of the previous surgery and to the subabdominal vessels from the intraperitoneal or preperitoneal area, the type of recurrent hernia can be easily determined by combining it with the medical history. More importantly, the previous surgery has already caused loss and damage to the inguinal region of the patient, and re-operation through the original incision would result in unclear anatomy and would easily cause complications such as recurrence and pain. Minimally invasive laparoscopic surgery is thus operated in a different surgical pathway, avoiding the above disadvantages. However, not every patient is suitable for laparoscopy, and the choice of surgical approach needs to be decided by the surgeon and the patient, regarding cost, affordability, patient age, and other factors. In our clinical work, we have learned that the laparoscopic technique for recurrent inguinal hernia has the following advantages: ① The posterior approach is used to avoid the shortcomings of the anterior approach. Because of the local scar tissue proliferation and anatomical changes in recurrent hernia, the anterior approach is more difficult, while laparoscopic hernia repair adopts the posterior approach with clear anatomical structure, does not destroy the anatomy of inguinal canal and levator muscle, and does not free the spermatic cord, so it will not damage the vas deferens and spermatic cord vessels and nerves, thus avoiding the occurrence of ischemic testicular inflammation. ②Reduced recurrence rate. In laparoscopic hernia repair, a large enough patch can be applied to completely cover the entire musculo-pubic foramen area, solving multiple problems in a single operation, resulting in a complete repair, eliminating the remaining hernia, reducing the possibility of new hernia, and reducing the recurrence rate after surgery. ③Good cosmetic effect, light postoperative pain, and quick recovery.