[Recurrent inguinal hernia. Intraoperative findings and cause of failure]

Recurrent inguinal hernia is still frequently observed today.

In order to evaluate factors causing failure of hernia repair 64 recurrent hernias are examined (63 men, 1 woman; age: min 32 years, max 88, median 60 years), 54 previously operated with "traditional" Italian surgical school techniques (Bassini and Postempskij) and 10 with "tension free" operations. For every patient previous surgical procedures, complications occurred, timing of recurrence and intraoperative findings at reoperation were recorded.

In the "traditional" hernioplasty group, 31 indirect and 23 direct hernias occurred; median relapse time was 11 years. In "tension free" techniques, 4 mesh suture failures (Lichtenstein), 2 mesh or plug dislocations (Trabucco) and 4 indirect hernias (mesh ring failures) were found at reoperation; median relapse time in this group was 2 years. The findings of a so long relapse time for traditional techniques was surprising, it is obvious now that every new "tension free" technique must have (at least) a such success rate. In the first group, inadequate technique of operation and physiologic weakening of the abdominal wall were responsible for the relapse, while in the second a technical failure was the main reason.

"Traditional" hernia surgery is now progressively abandoned in favour of "tension free" techniques, in which recurrences are due to the "physiologic" training period of the surgeon; mesh itself doesn't warrant success, but anatomical knowledge and an adequate dissection of musculo-fascial planes are mandatory.