Direct repair of a recurrent inguinal hernia involves an approach similar to an initial open operation. Identification of tissue planes may be difficult due to residual scarring. Careful dissection is required but even this may not reveal a clear plane beneath the external oblique aponeurosis.
The choice of operation is dependent on the defect:
If the reason for recurrence is infection e.g. an abscess or fistula, it may be necessary to undertake an operation to remove all foreign material before undertaking a definitive repair.
Closure of the posterior wall of the canal may not be possible without the exposure provided by orchidectomy. This must be discussed fully with the patient; it tends to be undertaken only in the elderly age group.
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