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>Journals >Cirujano General >Year 2004, Issue 4

Cisneros MHA
Inguinal hernia recurrence. What does it mean? Is it a semantic problem? Is it a language and interpretation problem? Is it the error of the millennium?
Cir Gen 2004; 26 (4)

Language: Español
References: 16
Page: 260-264
PDF: 4. Kb.

Full text


Objective: To demonstrate that the term “recurrence” is wrongly applied in the inguinocrural area in relation to the type of hernia according to the existing classifications; to propose a universal definition and criterion to denominate the real recurrence of inguinocrural hernia.
Setting: Private health care institution.
Design: Descriptive and observational study without control group. An interview with 15 questions was applied to 70 surgeons that perform inguinal hernioplasties, 55 Mexican surgeons and 15 members of the American Hernia Society (AHS) of different nationalities. We include the observations obtained from 96 patients re-operated from June 2001 to May 2004, with a diagnosis of “recurring” inguinal hernia and compared the operative findings of the surgical re-intervention with those of the primary surgery.
Results: 100% of the interviewed were unable to provide a concrete definition of recurrence. There were divergences in opinions between the AHS members, but the non-members (85%) agreed with the definition given in the conclusion, accepting that the three types of inguinal hernias are totally different. Fifty two percent did not accept that the femoral orifice belongs to the inguinal area; 80% accepted that most “recurrences” reappear as direct defects after repair without a mesh. Seventy five percent considered it mandatory that the defect must reappear in the same specific anatomic site of the primary hernia to be called recurrent. From the 96 re-operated patients, 81 had indirect hernia, eight a direct one, in seven patients the type of primary hernia was not known. During re-intervention, we found 84 direct defects, 5 indirect, and 7 mixed defects.
Conclusion: There is no formal consensus concept of recurrence in inguinocrural hernia. I propose to establish a universal definition and criterion to denominate a recurrence as such. Recurrence is: that hernia that reappears at the same specific anatomic site after a temporal surgical disappearance and that is classifiable as primary hernia”.

Key words: Inguinal area, inguinal hernia, recurrence classification.


  1. Gran Diccionario Enciclopédico Ilustrado Selecciones del Reader’s Digest. México-New York,1990; tomo 10: 3187.

  2. Diccionario Médico. Barcelona 2a ed. Editorial Salvat, 1974: 493-94.

  3. Rutledge RH. The Cooper’s ligament repair. In: Textbook Hernia. Nyhus and Condon, 5th ed. Philadelphia, PA, Ed. Lippincott Williams and Wilkins. 2000: 139-48.

  4. Gilbert AI. An anatomic and functional classification for the diagnosis and treatment of inguinal hernia. Am J Surg 1989; 157: 331-3.

  5. Nyhus ML, Bombeck T. Recurrent hernia. Sabiston En: Tratado de patología quirúrgica. 10ª ed. México Interamericana. 1978: 1093-1110.

  6. Celdrán A, Souto L. Recidivas después de hernioplastía sin tensión, fundamentos y técnicas de la hernioplastía sin tensión. Madrid, España. ed. Fundación Jiménez Díaz. 1999: 99-103.

  7. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. The tension-free hernioplasty. Am J Surg 1989; 157: 188-93.

  8. Gilbert AI, Graham MF, Voigt WJ. A bilayer patch device for inguinal hernia repair. Hernia 1999; 3: 161-6.

  9. Gilbert AI, Graham MF, Voigt WJ. The lateral triangle of the groin. Hernia 2000; 4: 234-7.

  10. Fruchaud H. Anatomie chirurgicale des hernies de l’aine. París. ed. G. Doin & Co., 1956: 247-61.

  11. González OA, Lancaster JB, Robles PP, Álvarez QR. Clasificación anatómica de las hernias inguinales. Cir Gen 1998; 20(Supl 1): 9-11.

  12. Zugaib AR, Erwin MW. Etiopatogenia de las hernias inguinales. En: Mayagoitia JC. Hernias de la pared abdominal. Tratamiento actual. México; Mc Graw-Hill. 2003: 67-71.

  13. Mathias K. Extraperitoneal origin of groin hernia. In: Textbook Hernia. Nyhus and Condon. 5th ed. Philadelphia, PA. Ed. Lippincott Williams and Wilkins. 2000: 45-53.

  14. Rutkow IM, Robbins AW. The mesh plug technique for recurrent groin herniorrhaphy: a nine-year experience of 407 repairs. Surgery 1998; 124: 844-7.

  15. Celdrán A, Vorwald P, Meroño E, Ureña MA. A single technique for polypropylene mesh hernioplasty of inguinal and femoral hernias. Surg Gynecol Obstet 1992; 175: 359-61.

  16. Cisneros MHA, Mayagoitia GJC, Suárez FD. Hernioplastía inguinal híbrida libre de tensión “De Cisneros”. ¿La mejor opción para evitar recurrencias? Cir Gen 2003; 25: 163-8.

>Journals >Cirujano General >Year 2004, Issue 4

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