الفهرس 
Anatomy of Inguinal CanalOnly 14 pages are availabe for public view
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Abstract
Recurrent hernia still represents an important challenge for hernia surgeons and the results remain poor. Its treatment is more complex than treatment of primary hernia, for several reasons: the high incidence of combined hernias, the need for tension-free repair and closure of all potential hernia sites, the age-related weakness of the connective tissue, and the difficulty of dissection due to scar tissue and anatomical changes (Haapaniemi et al., 2001).
The overall incidence of recurrent inguinal hernias is about 15 per cent. Most recurrences were observed early within the first 5 years. In addition, it is been found that 66 percent of recurrences occurred after 10 years from the last repair. The longer the follow up the more likely the hernia is to recur regardless of the type of the previous repair. These findings support the theory that a recurrence may be the result of mesenchymal metabolic defect with abnormality in collagen synthesis and breakdown. This is further confirmed by the lower recurrence rate whenever a synthetic material is added to any repair to strengthen weak tissue (Knook et al., 1999).
The recurrence rate after repairing a recurrent inguinal hernia using the anterior trans-inguinal approach can be as high as 36 percent. To achieve better results, several different approaches have been tried. Better results were obtained with excision of the cord and canal closure, which dropped the re-recurrence rate to 5 percent (Heuman et al., 1999). To avoid the scar tissue of the previous repair attention started to shift toward the open preperitoneal mesh repair as the preferred technique to repair a recurrent inguinal hernia (Stylopoulos et al., 2003).