BACKGROUND Recurrent and complex bilateral inguinal hernias are associated with a high recurrence rate. Giant prosthetic reinforcement of the visceral sac (GPRVS) is popular in America and Europe, but there are no prospective data from Iran. PATIENTS AND METHODS From 20 March 1995 to 20 March 2003, 234 patients (227 men and 7 women) with 420 inguinal hernias (186 bilateral and 48 unilateral) underwent repair using a large polyester mesh based on Stoppa's preperitoneal technique. Mean age was 60 years (range 25 to 88) and 44.8% had one or more comorbid conditions. In 154 instances, the relapsed hernia had already been operated once or twice for recurrence. RESULTS Mean hospital stay after surgery was 2.2 days (range 1-13 days). The mean operative time was 45 minutes (range 30-75 minutes). General complications were one case of upper gastrointestinal bleeding, one case of ileus and one case of atelectasis. Local complications consisted of three local seroma formations. In no instance was postoperative neuralgia, chronic pain or testicular atrophy, mesh infection or death reported. Follow-up was obtained in all patients. The recurrence rate was 0.71% (3 of 420) per inguinal repaired or 0.85% (2 of 234) per patient. Factors predicating a high risk for recurrence included large hernia size (>5 cm), failure of one or more previous repairs (65.8%, 154 of 234), chronic cough and associated lower abdominal hernias. CONCLUSION GPRVS is anatomic, sutureless, tension-free and the absolute weapon to eliminate all type of groin hernias. No other technique produces better results for the repair of recurrent and re-recurrent groin hernias.