[Inguinal hernia repair modified by Kirschner. A critical analysis after 11 years of clinical experience]

In a retrospective study the early and late complications and the recurrence rate of inguinal hernia 10 years after elective repair by a modification of Kirschner's procedure are presented and compared with those following other established surgical techniques. Questionnaires were sent to 1400 patients, and 1029 patients (73.5) also underwent clinical examination. With all techniques, the most frequent postoperative complications were haematomas and seromas (10.1%). Postoperative mortality was 0.2%. Late complications were reported by 36.4% of the patients followed up by questionnaire. The most frequently reported symptom (by 23.8%) was transitory hypaesthesia in the scar area. In 2.7% of the male patients examined testicular atrophy was found. All patients who reported a recurrence on their questionnaire underwent follow-up examination in the clinic. Thus, the cumulative recurrence rate was 9.6%. Over two-thirds of all recurrences were lateral recurrences (P < 0.01). It was not possible to determine potential risk factors for a recurrence of inguinal hernia. The recurrence rate increased with time before follow up: among the patients examined after 5 years the recurrence rate was 5.7%, while it was 12.1% for patients examined after a period of 10 years. Kirschner's modification involves a risk of lateral recurrence that should not be underestimated, and its use should be reconsidered. The Shouldice repair appears to be the method of choice. However, further results confirming this choice should be awaited.