title: Operative findings in recurrent hernia after a Lichtenstein procedure.
abstract: BACKGROUND
  Recurrence after inguinal herniorraphy continues to be a problem, although the Lichtenstein technique (anterior, open fixated sheet mesh) is associated with reduced recurrence rates. Recurrence after Lichtenstein repair is suspected to be caused by insufficient fixation and overlap at the pubic tubercle.
  
  
  METHODS
  A review was made of 87 records from operations for recurrence after a previous Lichtenstein procedure, based upon national and large area data bases, recording 95% (Denmark) and 50% (Sweden) of all inguinal hernia operations.
  
  
  RESULTS
  Direct recurrences were found in 62%, whereas the remaining recurrences were either indirect (17%), femoral (13%), or other/unclassified (8%).
  
  
  CONCLUSIONS
  The most plausible explanation for the development of the direct recurrences is an insufficient medial mesh fixation and overlap over the pubic tubercle. Avoidance of more than half of the recurrences after the Lichtenstein repair may be obtained by increased attention to this specific technical aspect of the operation.
authors.affiliation: Department of Surgical Gastroenterology, Hvidovre University Hospital, Hvidovre, Denmark. herniedatabasen@hh.hosp.dk
authors.forename: M
authors.initials: M
authors.lastname: Bay-Nielsen
authors.forename: P
authors.initials: P
authors.lastname: Nordin
authors.forename: E
authors.initials: E
authors.lastname: Nilsson
authors.forename: H
authors.initials: H
authors.lastname: Kehlet
mesh_terms: D006552:Hernia, Inguinal / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh; D013514:Surgical Procedures, Operative / Q000379:methods