The anatomic defects of recurrent groin hernia in 413 patients treated consecutively using the preperitoneal approach have been cataloged and the results of the repair evaluated. No specific predicting factors could be identified for most of the patients. Defects are highly variable and not at all predictable. Pure direct defects predominated (58 percent), tended to be at the tubercle (41.9 percent), and were relatively small (less than 4 cm in 77 percent of the patients). Recurrence was associated with a number of previous repairs but the rate was only 4.3 percent for the series with 11 of 18 patients having at least three repairs. The recurrence rate for first rerepair using this approach was 1.6 percent (4 of 248 patients) within 5 years for 80 percent of the patients followed. The preperitoneal approach is a useful, safe, and effective technique for the treatment of recurrent groin hernia and should be widely implemented.