These are just some postulates of mine, but another fascinating fact, perhaps, at least for indirect hernia, is the hernial sac. I think there will be no hernia without a sac, even if you have a large ring. I believe sac formation is a random event. In children they just ligate sac, nothing more. Then as child grows up, everything changes position and hernia is cured by nature. I think that if you ligate a sac in an adult you have hernia cured, too. The reason is that there’s no way abdominal contents can escape outside. Difference is that there’s no growth and defects will remain. Thus hernia can recur, but maybe it could take years for another random event, or simply never happen again. I’m not so sure about direct hernia. An important reason why hernia recurs so often is that surgeons often don’t ligate sacs high enough or not all sacs. A sac can be invisible during surgery so you need a trained surgeon to look for them patiently. Dr. Kang and Shouldice Clinic do that, but I’m not that sure all surgeons do that. I’d like to know about other people’s thoughts here.