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Updated: Jan 12, 2026
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
A Prospective Comparative Study of Shouldice Inguinal Hernia Repair and Total Transabdominal Preperitoneal (TAPP)
Chintankumar Patel1, Dinesh Prasad2, Vipul D Yagnik3
1Surgery, Surat Municipal Institute of Medical Education and Research, Surat, IND.
Background:
More than 20 million hernias are repaired annually. This study aimed to compare two techniques, Shouldice hernia repair and transabdominal preperitoneal (TAPP) laparoscopic hernia repair, in terms of various measures, such as recurrence rates, intraoperative and postoperative complications, and length of postoperative stay.
Methods:
A single-center, prospective, comparative study was conducted among patients admitted to a tertiary care hospital with a diagnosis of primary inguinal hernia (direct or indirect). A total of 125 patients underwent surgery. Among these patients, 53 had bilateral inguinal hernias, and 72 had unilateral inguinal hernias. The patients were alternatively allocated (based on their outpatient department visits) to either TAPP laparoscopic hernia repair or Shouldice hernia repair. All patients were followed up both in the short term (on postoperative days 1, 3, and 15) and in the long term (at 6 and 12 months) on an outpatient basis. Follow-up included a clinical examination and ultrasonography to assess recurrence and complications, such as postoperative pain, seroma formation, testicular atrophy, inguinodynia, foreign body sensation, and recurrence.
Results:
The mean operative durations of the Shouldice and laparoscopic TAPP groups were 82.7 ± 12.9 minutes and 107.6 ± 13.8 minutes, respectively, indicating that significantly less time was needed for Shouldice repair (p = 0.001). Postoperative pain was measured on days 1, 3, and 15, and visual analog scale scores were compared. Comparing the two procedures for pain on days 1, 3, and 15, there was less pain associated with the Shouldice repair than with the TAPP repair. However, this difference was not statistically significant (p = 0.2199). Seroma formation and testicular atrophy were significantly greater in the TAPP group than in the Shouldice group (p = 0.047 and p = 0.0194, respectively). Inguinodynia was significantly greater in the laparoscopic group than in the Shouldice repair group (p = 0.029). At the 12-month follow-up, there was one case of recurrence after Shouldice hernia repair (1.1%) and two cases of recurrence after TAPP laparoscopic hernia repair (2.2%). This difference was not statistically significant (p > 0.05).
Conclusion:
The operative time was significantly shorter for Shouldice than for laparoscopic TAPP. Postoperative pain and recurrence rates were comparable in both groups, whereas the seroma and testicular atrophy rates were higher in the laparoscopic TAPP group.
