A follow-up study on recurrence after inguinal hernia repair.

A follow-up study of 178 adult patients with primary inguinal hernia repair revealed significantly fewer recurrences after the McVay operation for a pure direct hernia than for a pure indirect hernia. The recurrence rate for pure indirect hernias was 19.3 +/- 4.3 per cent after ten years and 20.7 +/- 4.6 per cent after 15 years. The mean observation time was 11 years, 98 patients. The recurrence rate for pure direct hernias was 4.1 +/- 2.8 per cent after ten years and 7.5 +/- 4.5 per cent after 15 years. The mean observation time was 13 years, 52 patients. Twenty-eight patients treated for a pure indirect hernia with a simple abdominal ring repair had no recurrences after a mean observation time of ten years. We suggest that the reason for the higher recurrence rate among patients treated with a McVay repair for an indirect inguinal hernia might be due to the interference with the healthy posterior wall of the inguinal canal, since 50 per cent of the recurrences in this group were direct. It is stressed that abdominal ring repair should be the treatment of choice for indirect hernias.