Background <p>Knowledge of long-term outcomes following elective inguinal hernia mesh-repair in patients with inflammatory bowel disease (IBD) remains limited. Pathophysiological differences between Crohn’s disease (CD) and ulcerative colitis (UC) may influence mesh-related complications and recurrence risk. The primary objective was to assess the reoperation risk for mesh-related complications, and secondarily, recurrence after inguinal hernia mesh-repair in patients with CD and UC. The impact of fistulising disease (intra-abdominal/perianal) and surgical technique (open/laparoscopic) on both outcomes was also analysed based on the available data.</p> Methods <p>This nationwide cohort study (2007–2016) followed IBD patients undergoing elective inguinal hernia mesh-repair to assess risks of reoperation for mesh-related complications or recurrence. Risks were estimated using cumulative incidence and Cox regression analyses.</p> Results <p>Among 1,072 patients with IBD (CD = 264, UC = 698, IBD-unclassified = 110), the five-year reoperation risk was 0.5% for mesh-related complications and 5.7% for recurrence. Fistulising disease was present in 6.9% (<i>n</i> = 74) of all patients with IBD: perianal in 95% (<i>n</i> = 70) and intra-abdominal in 5% (<i>n</i> = 4). There were too few mesh-related complications (<i>n</i> = 5) to support statistical analysis of this outcome. Recurrence risk was not significantly affected by IBD subtype: CD (reference), UC (HR = 1.67, 95% CI: 0.77–3.64), IBD-U (HR = 0.91, 95% CI: 0.24–3.44), or surgical technique: transabdominal preperitoneal (TAPP) (reference), and Lichtenstein (HR = 0.80, 95% CI: 0.43–1.47).</p> Conclusion <p>This study suggests that inguinal hernia mesh-repair is also safe among IBD patients regardless of subtype, surgical technique, or perianal fistulation. Similarly, recurrence risk was unaffected by these factors. Limited data prevented conclusions on intra-abdominal fistulising disease as a potential risk-factor for poor surgical outcomes.</p>