The preperitoneal approach in the repair of recurrent inguinal hernias

Preperitoneal repair of 98 recurrent inguinal hernias performed at our teaching hospital was studied. In 55 instances, primary closure was performed and in 43 hernias, mesh prosthesis was applied. Rerecurrence was seen after 32 corrections (a follow-up examination period of 45 months). Nine asymptomatic recurrences were found. Unilateral versus bilateral repair showed a 27 and 50 per cent recurrence rate, respectively (p = 0.037). Results after primary closure and after mesh application were similar, and no correlation with the number of recurrences, age or presence of causes of raised abdominal pressure was observed. In 20 reoperations performed after the follow-up date, ten lateral hernias were found, indicating technical failure as a possible cause of rerecurrence. A high rate of recurrence after preperitoneal approach for recurrent inguinal hernia may be explained by technical shortcomings and detection of a high percentage of asymptomatic recurrences at physical examination.