In Sik Jang, et al. tigate its clinical usefulness. METHODS Subjects Among the 191 patients who were diagnosed with in- guinal hernia and who underwent TEP hernia repair at these authors’ hospital within the period from June 2006 to January 2010, 24 patients with bilateral hernia and 15 pa- tients with a previous history of pelvic surgery were excluded. Among the remaining 152 patients, 19 patients with recurrent hernia were selected as subjects. The pa- tients with bilateral hernia were excluded as no bilateral hernia existed in the group with recurrent inguinal hernia. Laparoscopic TEP hernia repair was conducted by a single surgeon in all the cases. The gender, age, number and method of the previous surgeries, time elapsed from the surgery to the recurrence, recurrent hernia type, operation time, hospital stay, and recurrence after surgery were ret- rospectively examined based on the medical records. Chi-square test was conducted, using SPSS (SPSS Inc., Chicago, IL, USA) for statistical analysis. Statistical sig- nificance was pegged at P ＜ 0.05. Methods In a supine position after general anesthesia, a skin in- cision was made 15 mm vertically to the directly inferior umbilicus. The anterior rectus sheath in the direction of the hernia was exposed and then incised. The index finger was inserted between the back side of the rectus abdomi- nis muscle and the posterior rectus sheath, and dissection was done inferiorly to create a space for two index finger knuckles. Then a distention balloon was inflated using Spacemaker (Autosuture, Norwalk, CT, USA), with a 10-mm balloon trocar and a distention balloon combined to secure the appropriate space. After removing the bal- loon, the balloon trocar was filled with about 25 mL air and 12 mmHg CO2 gas, followed by camera insertion. A 5-mm trocar was inserted 5 mm directly superiorly to the pubic symphysis and 5 mm superiorly to the middle of the cam- era insertion trocar and the pubic trocar to secure the nec- essary space for the surgery. The space was secured to suf- 314 ficiently expose the central line and the pubic symphysis internally, the anterior superior iliac spine laterally, Cooper’s ligament and the psoas muscle inferiorly, and the rectus abdominis anteriorly. The hernia sac was repaired in almost all the cases (which led to a longer operation time). In the case of large and damaged hernia sacs, they were incised and removed after ligation. Parietex (Sofra- dim, Formans, France) mesh, which is made of polyester with good compliance and ease of use [6], was used. MIf the patient’s height was 175 cm or lower, the 13 × 9 cm size mesh was used, and if the patient was taller than 175 cm, the 15 × 10 cm size mesh was used, based on the previous related experiences. Initially, the mesh was not fixed in pa- tients with unilateral hernia, but it was later fixed at the lat- eral pubic symphysis, Cooper’s ligament, and lateral ante- rior abdominal wall, respectively, using Tacker (Autosu- ture), for surgical convenience, since 2009, except for the case of the easy spread of the mesh. When the mesh was sufficiently unfolded, the CO2 gas was blocked and was then slowly released through the trocar on the suprapubic area. After confirming the complete release of the CO2 gas, the trocar was removed, and the surgery was completed. RESULTS Clinical aspects The 152 subject patients consisted of 133 patients (87.5%) with primary inguinal hernia (hereinafter referred to as “group P”) and 19 patients (12.5%) with recurrent in- guinal hernia (hereinafter referred to as “group R”). The male-to-female ratio was 127:6 for the primary-hernia group and 18:1 for the recurrent-hernia group, showing a higher male proportion. The mean age was 56.4 years for the primary-hernia group and 55.6 years for the re- current-hernia group. For recurrence, there were 16 first-recurrence cases (84.2%) and three second-recurrence cases (15.8%) (Table 1). For the time that relapsed from the surgery to the re- currence in the group R, there were two cases (10.5%) with one year or less, two cases (10.5%) with two years or less, three cases (15.8%) with five years or less, three cases (15.8%) with 10 years or less, and nine cases (47.4%) with thesurgery.or.kr