Recurrence after inguinal hernia repair at ten years by open darn, open mesh and TEP--no advantage with mesh.

BACKGROUND: Whilst mesh repair is now standard in inguinal hernia surgery, with the expectation of a reduction in recurrence rate, the incidence of recurrent hernias shows little evidence of decline. Long-term follow-up studies after hernia surgery are few.
METHODS: 1361 patients underwent 1473 inguinal hernia repairs by open mesh, open sutured or total extraperitoneal (TEP) techniques with more than ten years' follow-up.
FINDINGS: Recurrence rates after open mesh and open sutured repair were similar. There has been no benefit in terms of declining recurrence from the increasing use of mesh. There was a high rate of early recurrence after TEP due to learning curve effects. Late recurrence, occurring after two years was uncommon with all techniques, but was lowest after TEP, double the rate after open mesh and four times the rate after sutured repair. This may be due to mesh protecting the area of muscle weakness' with larger meshes conferring a greater long-term benefit.
CONCLUSION: Our findings help to explain why there has been no significant fall in the incidence of recurrent inguinal hernias in national data sets and large scale audits, despite a widespread use of mesh.