[Pro-Shouldice: primary tension-free hernia repair--conditio sine qua non?]

Protagonists of laparoscopic hernia repair with mesh emphasize the tension-free repair as a main advantage. Thus, conventional techniques of hernia repair with tissue approximation and suture lines are questioned. Postulated advantages of the tension-free repair are less postoperative pain, shorter labour disability, less recurrences and less complications. The results of our own patients (primary hernia n = 2025, recurrent hernias n = 897) operated with the Shouldice technique were evaluated with regard to the postulated advantages of the tension-free repair. 95% of our patients were operated under local anesthesia. The amount of analgetic drugs/patient decreased from 45% first postoperative day to 20% second postoperative day. The individual judgement of pain with a visual analogue scale decreased to zero at the second postoperative day. Chronic groin pain persisted in 1.4% after primary hernia repair and 2.6% after repair of recurrent hernias in our patients. Mobilizing the patient from the operating table the postoperative hospital stay is 3,7 days after primary hernia and 6,7 days after recurrent hernia. The length of labour disability correlated significantly with the occupation. 90% of self-employees are back at work 3 weeks postoperatively while, in the group of employers, it lasts 8 weeks. 5-year follow-up reveals a recurrence rate of 1.3% after primary hernia and 3.1% after recurrent hernia. With the Shouldice repair the modern goals of hernia surgery are feasible. Therefore, a primary tension-free repair is not a "conditio sine qua non".