The Challenges and Benefits of an Open Anterior Repair of Recurrent Inguinal Hernias: A Cohort Study

INTRODUCTION: Recurrent inguinal hernia repair presents unique clinical challenges. While minimally invasive surgery (MIS) is often preferred, open anterior mesh repair is a valid approach particularly when requiring mesh, suture, or tack removal. This study evaluates the outcomes of a small incision open anterior mesh repair, including foreign body (FB) removal, in an Australian cohort. METHODS: Retrospective analysis of patients who underwent open anterior mesh repair for a clinically detectable recurrent inguinal hernia at a tertiary centre. Demographics, hernia history, intraoperative findings, anaesthetic technique, complications, and follow-up symptoms were analysed. RESULTS: From 2001 to 2024, 173 patients were included (97.7% male, median age of 66). Swelling (54.9%) was the most common symptoms. 82.7% had a prior open repair, same-day procedures occurred in 40% and 13.3% were treated under local anaesthesia with sedation. FB removal was done in 15.6% of patients. The overall complication rate was 10.4%, wound or spermatic cord haematoma (5.2%) was the most common. At median follow-up of 35.7 months, (range 9.7-163 months), 92.3% were pain-free. Minor discomfort occurred in 7.6%, no patient reported moderate or severe pain and re-recurrence is 5.2%. No major complications occurred during FB removal. Subgroup analysis showed no significant difference in outcomes based on the prior repair approach, FB removal, or nerve management. CONCLUSION: Open anterior mesh repair for recurrent inguinal hernia is safe and effective, even after prior anterior repairs, and enables safe removal of FBs. Maintaining proficiency in open techniques is important given the increasing use of MIS in primary hernia repair.