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Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia.
A N Kingsnorth1, M R Gray, D M Nott
1University of Liverpool, Department of Surgery, Royal Liverpool University Hospital, UK.
The British Journal of Surgery
|October 1, 1992
Summary
The Shouldice repair for inguinal hernias showed similar recurrence rates to plication darn in a randomized trial. Further surgeon training is recommended for the Shouldice technique to potentially lower recurrence rates.
Area of Science:
- Surgical innovation
- Hernia repair techniques
- Clinical trial methodology
Background:
- Specialized hernia clinics achieve lowest recurrence rates.
- The Shouldice repair is a standardized operation performed by specialist surgeons.
- Surgeon experience may influence inguinal hernia repair outcomes.
Purpose of the Study:
- To compare the Shouldice repair with plication darn for inguinal hernias.
- To evaluate recurrence rates and complications in a randomized trial.
- To assess surgeon-dependent variables in Shouldice repair outcomes.
Main Methods:
- A prospective randomized trial involving 322 inguinal hernias.
- Comparison of Shouldice repair versus plication darn.
- Fifteen general surgeons performed operations, with supervised training for junior surgeons on the Shouldice technique.
Main Results:
- Six-week complication rates for wound infection and hematoma were similar between groups.
- No significant difference in recurrence rates was observed between Shouldice repair (7 recurrences) and plication darn (4 recurrences) after a mean 30-month follow-up.
- Similar numbers of sliding hernias were present in both groups.
Conclusions:
- The Shouldice repair and plication darn demonstrated comparable recurrence rates in this trial.
- The study suggests that additional supervision for junior surgeons during the Shouldice repair learning period may be beneficial.
- Standardized operative techniques require adequate surgeon training to achieve optimal results.