Cooper's ligament repair: a 25-year experience with a single technique for all groin hernias in adults

In the belief that recurrences will be lower if all defects are repaired at the original operation, I performed a Cooper's ligament repair on all groin hernias in adult patients between 1959 and 1984, regardless of the hernia type. This series includes 1142 repairs in 942 patients. Follow-up has been 97%, with 80% of the patients being personally examined by the author. Excluding late deaths, 906 repairs in 747 patients have been followed up for an average of 9 years. There have been 18 recurrences, for a recurrence rate of 2% of live repairs. This breaks down to 1.9% for 779 primary hernias and 2.4% for 127 recurrent hernias. In primary hernias only the recurrence rates are 3.5% for 289 direct hernias, 1.1% for 459 indirect hernias, and 0% for 31 femoral hernias. Seventeen of the 18 recurrences have been indirect along the cord in a subgroup of 147 repairs done with a subcutaneously transplanted cord and followed for an average of 17.4 years (recurrence rate, 11.6%). This method was discarded in 1972. There has been only one recurrence in 572 repairs with the cord left in the natural position and followed for an average of 7.1 years (recurrence rate, 0.2%). This shows the value of not superimposing the internal and external rings (90% confidence limits that the recurrence rate is less than 0.7%). There has been no recurrence in 154 repairs in female patients or 33 repairs with orchiectomy followed for 8.1 and 8.8 years, respectively. A Cooper's ligament repair gives a strong posterior wall and repairs all the defects that can occur in the groin. It can be done safely on all adult groin hernia patients, with a recurrence rate lower than those reported for selective methods of repair.