Recurrence is a significant public health problem. So, this fourth Suvretta meeting, held in February 2006 is intended to concentrate on this problem. Technical nuances of the various operations have been discussed to pursue consensus concerning the best techniques. Methods were explored to improve surgeons' education and look into the multifactorial etiologies to understand the biology of hernia recurrence better.

Recurrence as an Important Endpoint.- Present State of Failure Rates (Clinical Studies and Epidemiological Database, Short- and Long-Term).- Recurrence as a Problem of the Trainee.- Failures in Hernia Surgery Done by Experts.- Biological Reasons to Fail.- Pervasive Co-Morbidity and Abdominal Herniation: an Outline.- Non-Surgical Risk Factors for Recurrence of Hernia.- The Instable Scar.- Biomaterials: Disturbing Factors in Cell Cross-Talk and Gene Regulation.- Hiatal Hernia.- Technical Pitfalls and Factors that Promote Recurrence (Small Defects) Following Surgical Treatment of Hiatal Hernia.- Anatomical Limitations of Surgical Techniques.- Prevention by Selection?.- Redo-Operations Open/Laparoscopically: Change of Technique or Make it Better?.- The Failed Laparoscopic Hiatal Hernia Repair: "Making it Better" at Redo Operation.- Change of Technique: With or Without Mesh?.- Some Laparoscopic Hiatal Hernia Repairs Fail - Impact of Mesh and Mesh Material in Crural Repair.- Abdominal Wall Closure.- Finding the Best Abdominal Closure - An Evidence-Based Overview of the Literature.- Closure of Transverse Incisions.- Biological Reasons for an Incisional Hernia.- Technical Pitfalls Favouring Incisional Hernia.- Bioprostheses: Are They the Future of Incisional/Acquired Hernia Repair?.- Incisional Hernia.- Whom to Operate?.- How to Create a Recurrence After Incisional Hernia Repair.- Anatomical Limitations - Where Are the Layers?.- Biomechanical Data - "Hernia Mechanics": Hernia Size, Overlap and Mesh Fixation.- How to Treat the Recurrent Incisional Hernia.- Open Repair.- Laparoscopical Repair.- Primary Inguinal Hernia.- How to Create a Recurrence.- How to Treat Recurrent Inguinal Hernia.- Treatment of Recurrent Inguinal Hernia.- Recurrence and Infection: Correlation and Measures to Decrease the Incidence of Both.- Inguinal Hernia Recurrence and Pain.- Recurrence and Mesh Material.- Mesh Explantation in the Groin.- The Mesh and the Spermatic Cord.- Principle Actions for Re-Recurrences.- Treatment of the Other Hernia.- Laparoscopic Repair of Recurrent Childhood Inguinal Hernias After Open Herniotomy.- The Femoral Hernia - the Bête Noire of Hernias!.- The Umbilical Hernia.- Parastomal Hernia: Prevention and Treatment.- Central Mesh Rupture - Myth or Real Concern?.- What Can We Do to Improve Our Results?.- Improved Teaching and Technique.- Analyzing Reasons and Re-Operation for the Inguinal Hernias Recurring After Mesh-Plug Procedure.- Standard Procedures for Standard Patients?.- Tailored Approach for Non-Standard Patients.- Identification of the Patients at Risk (for Recurrent Hernia Disease).- The Biological Treatment of the Hernia Disease.- Pharmacological Treatment of the Hernia Disease.- Concluding Recommendations to Prevent the Recurrence.- Questionnaire (39 Participants).