title: Repeated groin hernia recurrences.
abstract: OBJECTIVE
  To describe the characteristics of patients undergoing multiple groin hernia repairs and to identify strategies that prevent further recurrence.
  
  
  BACKGROUND
  Although relatively infrequent, recurrent groin hernias where several repairs have previously been undertaken constitutes a major problem in hernia surgery. Low numbers and heterogeneity have made it difficult to perform large prospective studies on this group.
  
  
  METHODS
  The study was designed as an observational population-based register study. All repairs for recurrent hernia recorded in the Swedish Hernia Register (SHR) 1992-2006 were identified. Risk for reoperation by number of previous repairs, with adjustment for gender and age, and risk for reoperation by unit responsible for previous repair were determined using Cox proportional hazard analysis.
  
  
  RESULTS
  There were 12,104 cases of hernia repaired once, 2 repairs in 4199 cases, 3 repairs in 310 cases, 4 repairs in 32 cases, and 5 repairs in 3 cases. The risk for further reoperation increased with the number of previous repairs (P < 0.001). The hazard ratios for reoperation following open preperitoneal mesh repair and laparoscopic repair decreased; whereas, the hazard ratio for sutured repair increased with the number of previous repairs. The difference between Lichtenstein repair and laparoscopic repair was significant for the first 2 repairs (P < 0.05).
  
  
  CONCLUSIONS
  Laparoscopic preperitoneal repair provides the best surgical outcome in repeated groin hernia recurrence.
authors.affiliation: Department of Surgery, University Hospital of Lund, Lund, Sweden.
authors.forename: Dan
authors.initials: D
authors.lastname: Sevonius
authors.forename: Ulf
authors.initials: U
authors.lastname: Gunnarsson
authors.forename: Pär
authors.initials: P
authors.lastname: Nordin
authors.forename: Erik
authors.initials: E
authors.lastname: Nilsson
authors.forename: Gabriel
authors.initials: G
authors.lastname: Sandblom
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006119:Groin; D006552:Hernia, Inguinal / Q000517:prevention & control* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D055502:Secondary Prevention; D013526:Surgical Mesh