Although most surgeons agree that the laparoscopic approach is ideally suited for the repair of recurrent inguinal hernias, there still is not total agreement on what approach should be used when a laparoscopic repair fails. Whether an open or laparoscopic approach should be utilized must be dictated by the experience of the surgeon. This is because the repair of recurrent laparoscopic inguinal hernias (RLHs) is challenging and requires advanced laparoscopic skills as well as an in-depth understanding of the posterior anatomy (Figs. 21.1 and 21.2). Before undertaking the laparoscopic repair of an RLH, a surgeon must also be totally comfortable utilizing the laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair since it is the safest laparoscopic approach for recurrent laparoscopic hernias. The indications for repair are the same as for any inguinal hernia and other than a lack of experience there is no absolute contraindication to the laparoscopic repair of RLH.

Before starting a laparoscopic repair of a recurrent laparoscopic hernia it is important to know the status of the peritoneal cavity. Since the laparoscopic repair will be transperitoneal, it is essential to know if there is likely to be extensive adhesions or adhesions at the umbilical level which might jeopardize the safety of the repair. The surgeon must have a game plan before beginning the repair. This means that the surgeon must know what is going to be done if confronted by the unexpected. There must be a plan that allows the procedure to be converted to an open anterior repair if needed. Finally, the surgeon must have a plan in place for closing the peritoneum or covering the mesh repair if re-peritonealization is impossible.