title: The impact of type of mesh repair on 2nd recurrence after recurrent groin hernia surgery.
abstract: BACKGROUND
  According to the Swedish Hernia Register (SHR), the reoperation rate is more than doubled after recurrent groin hernia repair compared with primary repair. The aim was to study the impact of type of mesh repair used in recurrent groin hernia surgery on a 2nd recurrence in a population-based cohort derived from the SHR.
  
  
  METHODS
  All 1st recurrent hernia repairs in the south-west region of Sweden, registered in SHR between 1998 up to 2007 were included. A questionnaire was sent in 2009. Patients stating a new lump or persisting problems were examined. A 2nd recurrence was identified as a 2nd reoperation or at physical examination. The incidence was analysed comparing anterior mesh repair (AMR) and posterior mesh repairs (PMR) (endoscopic and open).
  
  
  RESULTS
  Eight hundred and fifteen recurrent operations in 767 patents were analysed, 401 AMRs and 414 PMRs. PMR had a lower 2nd recurrence rate compared with AMR (5.6 vs. 11.0 %) (p = 0.025). An increased risk [3.21 (CI 1.33-7.44) (p = 0.009)] of a subsequent 2nd recurrence was seen after anterior index repair followed by AMR and a decreased risk [0.08 (CI 0.01-0.94) (p = 0.045)] after posterior index repair followed by AMR.
  
  
  CONCLUSIONS
  PMR in recurrent groin hernia surgery was associated with a lower 2nd recurrence rate compared to anterior. A posterior approach for 1st recurrent operation is recommended after an anterior index repair and an anterior approach after a posterior index operation.
authors.affiliation: Department of Surgery, Skåne University Hospital, 221 85, Malmö/Lund, Sweden, dan.sevonius@telia.com.
authors.forename: D
authors.initials: D
authors.lastname: Sevonius
authors.forename: G
authors.initials: G
authors.lastname: Sandblom
authors.forename: E
authors.initials: E
authors.lastname: Agger
authors.forename: S
authors.initials: S
authors.lastname: Smedberg
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
mesh_terms: D000368:Aged; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012086:Reoperation / Q000379:methods; D012307:Risk Factors; D013526:Surgical Mesh; D011795:Surveys and Questionnaires; D013548:Sweden