Surgeons’ preferences in the management of recurrence after laparoscopic inguinal hernia repair: A nationwide survey

Objective: This study aimed to evaluate contemporary surgical approaches and decision-making patterns of general surgeons in the management of recurrent inguinal hernia following laparoscopic inguinal hernia repair (LIHR), with particular emphasis on recurrence timing, surgeon experience, and annual laparoscopic case volume. Material and Methods: The questionnaire consisted of 26 items, including both multiple-choice and short-answer questions, and was designed to assess demographic characteristics, surgical experience, preferred surgical techniques, preoperative evaluation strategies, and management approaches for recurrent inguinal hernia following LIHR. Recurrences were classified as early (≤2 years) or late (>2 years) based on the postoperative time interval. Results: A total of 179 surgeons participated in the survey. Most respondents were male and had ≤10 years of surgical experience. Surgeons with higher annual laparoscopic hernia repair volumes were significantly more likely to prefer re-laparoscopic posterior approaches for both early and late recurrences, whereas surgeons with lower case volumes predominantly favored open anterior repair techniques (p<0.05). Surgical preferences also varied in female patients and according to the initial repair technique (transabdominal preperitoneal or total extraperitoneal). Nearly two-thirds of participants reported insufficient or only partially sufficient training in recurrent hernia repair, while the majority strongly agreed on the need for national or international clinical guidelines. Conclusion: Surgeon experience and annual laparoscopic case volume significantly influence the management of recurrent inguinal hernia following LIHR. As laparoscopic expertise increases, re-laparoscopic approaches are more frequently adopted. These findings highlight the need for standardized training programs and evidence-based guidelines to optimize the management of recurrent inguinal hernia after laparoscopic repair.