Inguinal hernia recurrence: classification and approach

We reviewed case reports, updated to January 2005, of 2,468 operations for groin hernia in 2,350 patients, including 277 recurrent hernias. The data obtained, following a simple anatomo-clinical classification into three types that could be used to orient surgical strategy, were: type R1--first recurrence of "high" oblique external reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; type R2--first recurrence of "low" direct reducible hernia with small (<2 cm) defect in non-obese patients after pure tissue or mesh repair; and type R3--all other recurrences, including femoral recurrences, recurrent groin hernia with large defect (inguinal eventration), multi-recurrent hernias, non-reducible contralateral primary or recurrent hernia, and situations compromised by aggravating factors (e.g. obesity) or otherwise not easily included in R1 or R2 after pure tissue or mesh repair.