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World J Surg. 2018 Jul;42(7):2001-2010. doi: 10.1007/s00268-017-4433-5.

Has Shouldice Repair in a Selected Group of Patients with Inguinal Hernia Comparable Results to Lichtenstein, TEP and TAPP Techniques?

Author information

1
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany. ferdinand.koeckerling@vivantes.de.
2
Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, 03044, Cottbus, Germany.
3
StatConsult GmbH, Halberstädter Strasse 40 a, 39112, Magdeburg, Germany.
4
3Surgeons, Klosterstrasse 34/35, 13581, Berlin, Germany.
5
Department of General Surgery Wilhelminenspital, Medical Faculty, Sigmund Freud University, Montleartstrasse 37, 1160, Vienna, Austria.
6
Department of Surgery and Center for Minimally Invasive Surgery, Academic Teaching Hospital of Charité Medical School, Vivantes Hospital, Neue Bergstrasse 6, 13585, Berlin, Germany.

Abstract

BACKGROUND:

In the new international guidelines only the mesh-based Lichtenstein, TEP and TAPP techniques are recommended. This present analysis of data from the Herniamed Registry compares the outcome for Shouldice versus Lichtenstein, TEP and TAPP.

METHODS:

Propensity score matching analyses were performed to obtain homogeneous comparison groups for Shouldice versus Lichtenstein (n = 2115/2608; 81.1%), Shouldice versus TEP (n = 2225/2608; 85.3%) and Shouldice versus TAPP (2400/2608; 92.0%).

RESULTS:

The most important characteristics of the Shouldice patient collective were younger patients with a mean age of 40 years, a large proportion of women of 30%, a mean BMI value of 24 and a proportion of defect sizes up to 3 cm of over 85%. For this selected patient collective, propensity score matched-pair analysis did not identify any difference in the perioperative and one-year follow-up outcome compared with TAPP, fewer intraoperative (0.5 vs. 1.3%; p = 0.009) but somewhat more postoperative complications (2.3 vs. 1.5%; p = 0.050) compared with TEP and advantages with regard to pain at rest (4.6 vs. 6.1%; p = 0.039) and on exertion (10.0 vs. 13.4%; p < 0.001) compared with the Lichtenstein technique.

CONCLUSION:

For a selected group of patients the Shouldice technique can be used for primary unilateral inguinal hernia repair while achieving an outcome comparable to that of Lichtenstein, TEP and TAPP operations.

PMID:
29299648
PMCID:
PMC5990577
DOI:
10.1007/s00268-017-4433-5
[Indexed for MEDLINE]
Free PMC Article

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