Objective: To assess the clinical efficacy of laparoscopic repair of recurrent inguinal hernia based on grading of the degree of difficulty. Methods: The clinical data of 34 patients with recurrent inguinal hernia undergoing laparoscopic repair between May 2009 and November 2015 in Xiangya Hospital, Central South University were retrospectively analyzed. Results: The entire group of patients was classified as surgical difficulty grade 1 in 13 cases, grade 2 in 15 cases and grade 3 in 6 cases. Patients with surgical difficulty grade 1 or 2 underwent hernioplasty by using a trans-peritoneal approach (TAPP), while those with surgical difficulty grade 3 underwent hybrid surgery. Operation was successfully completed in all patients, and the mean operative time was (90±27) min. After operation, three patients developed seroma which was resolved by needle aspiration in two cases and healed spontaneously in one case. Visual Analogue Scale (VAS) on postoperative day was 2.0±0.6, and the median Inguinal Pain Questionnaire (IPQ) score was 2.4 (range 0-8) at one month after operation. The median follow-up for all patients was 36 months, during which time, one case (3%) had a recurrence again. Conclusion: For an experienced surgeon, laparoscopic repair of recurrent inguinal hernia based on difficulty grading strategy was safe and effective.