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[Prospective controlled study comparing laparoscopy and the Shouldice technique in the treatment of unilateral
Abstract:
Between October 1992 and September 1994, 70 patients presenting with primary unilateral hernia were randomly assigned to either a transabdominal preperitoneal laparoscopic (group L) repair (n = 35) with a 3 x 5 inch polypropylene mesh or a conventional Shouldice repair (group S) (n = 35). The series consisted of 60 men and 10 women, with a median age of 56 years and a BMI of 24. We used the Nyhus classification; there were 25 type 2, 24 type 3a and 21 type 3b hernias. Preoperative characteristics of both groups were equivalent. When comparing group L to group S, we noted a similar operative time (65 +/- 20 min) and a similar postoperative hospital stay (3.8 +/- 1.3 days). The postoperative pain that was evaluated on a visual analogue scale (score from 0 to 10) was lower in group L. On the first and third postoperative day, the mean score was 3.4 +/- 1.5 and 1.3 +/- 1.4 in (group L compared) to 5.3 +/- 1.9 (p < 0.001) and 2.8 +/- 1.8 (p < 0.005) in group S. Significant morbidity occurred in 7 patients of group L: 3 seromas and 4 cases of orchitis, and in 5 patients of group S: 1 wound abcess, 2 cases of chronic neuralgia and 2 cases of orchitis. We recorded a quicker return to home activities in group L: 6 +/- 2 versus 10 +/- 4 days (p < 0.05) in group S but time off work was similar in both groups (30 +/- 9 days). All patients were evaluated in April 1996: the median follow-up was 30 months (range: 19-42 months). We recorded 1 recurrence in group L and 3 in group S. Statistical analysis revealed that the recurrence rate, for patients older than 50 and presenting with type 3 hernia, was higher in group S (3/14 = 21%) than in group L (0/13 = 0%). In conclusion, compared to Shouldice repair, laparoscopic herniorrhaphy is associated with less postoperative pain, a quicker return to everyday activities and an equivalent postoperative morbidity. In our series, the recurrence rate was even lower for patients older than 50 with type 3 hernia.