Purpose In our centre during distal Hypospadias repair the preference is to reconstruct the foreskin, unless parents request circumcision (e.g. for religious reasons). Our hypothesis is that foreskin reconstruction in distal Hypospadias reduces the long-term risk of complications. This study aims to test this hypothesis by retrospectively comparing the complication rates of distal Hypospadias repairs with and without foreskin reconstruction. Material and Methods A retrospective case note review was performed of distal Hypospadias repairs between September 2003 and December 2006. Information about type of Hypospadias, presence of chordee, surgical procedure, surgeon, post-operative complications including readmission, urethral fistulae, wound infection and dehiscence, meatal stenosis, foreskin complications, and details of any further surgery were recorded. Comparisons were made using Fisher exact test, p<0.05 taken as statistically significant. Results 146 cases were identified (Matthieu 130, Snodgrass 8, MAGPI/meatoplasty 8). 117 (80%) had foreskin reconstruction and 29 (20%) were circumcised. 12 were lost to follow-up. Follow-up averaged 3.3 years (range 2.3 to 5.7). Long-term complications (3 fistulae, 7 foreskin complications) occurred in 10 of 110 (9%) of foreskin reconstructions, and 6 of 24 (25%) in the circumcised group (2 fistulae, 2 meatal stenoses, 2 dehiscences). Foreskin reconstruction significantly reduced long-term complications, p<0.05 Fisher exact test. There was no significant difference in long-term complications for trainees compared to specialists. Conclusions Foreskin repair significantly reduces complications in distal Hypospadias repair, and is a reliable technique for both specialists and trainees.