BACKGROUND: Since the mid-1990s, PerFix(R) plug hernioplasty has become one of the mainstays of hernia surgery. We previously reported the preliminary results of the PerFix(R) plug hernioplasty in 2003. Here we report the results of a 5 year follow-up study of PerFix(R) plug hernioplasty. METHODS: From May 2000 to April 2005, 326 PerFix(R) plug repairs were performed. The operation times, lengths of hospital stay, visual analogue pain scales, time of analgesics use and complications and recurrence rates were evaluated prospectively. RESULTS: 326 cases underwent mesh-plug hernioplasties, 285 with inguinal hernias primary, 35 with recurrent hernias and 6 with femoral hernias. 218 and 101 cases were indirect and direct hernias, respectively. The mean age was 59.8 years. The male to female ratio was 289 : 15. Cardiovascular disease is the most common associated disease. The mean operation time was 31 minutes. The mean length of hospital stay was 2.5 days. The mean length of analgesics use, acetaminophen (1T: 300 mg p.o) and Nubaine (5 mg IM), were 1.89 and 0.5, respectively. Seventy-six (23%) cases developed a postoperative complication with urinary retention being the most common. During the follow up period from 12 months to 6 years, the overall recurrence rate was 0.6% (n=2). CONCLUSIONS: Tension-free repair of an inguinal hernia by PerFix(R) plug is a simple and secure method with less pain, quick operation times, short hospital stays, low complication rates and low recurrence rates.