The Bassini-Houdard type herniorhaphy. Long-term results and factors of recurrence

The aim of this long term study was to confirm that long term results are worsening with time and to establish the factors favourising recurrence. The study was retrospective and concerned 751 inguinal herniorraphies, performed from 1972 to 1982 according to the Bassini procedure modified by Houdard. The mean follow-up was 180.3 +/- 45.2 months (16.2-250.6). Available information was collected for 565 (75.3%) cases. The recurrence rate was 10%. The mean time between operation and recurrence was 102 +/- 65.6 months (6.1-226.3). The recurrence rate was lower for indirect hernias (4.7%) than for the group of direct, combined and sliding hernias (16%), (p < 0.00001). For recurrent hernias the recurrence rate was 22% versus 8.9% in primary herniorraphies (p > 0.01). This study suggests that recurrences can occur a long time after primary surgery because of parietal weakening with time; the low recurrence rate in indirect hernias does not justify the use of prostheses in this type of hernias, then higher rate in direct, combined, sliding and recurrent hernias warrants wider use of prostheses.