Short-term outcome after mesh or shouldice herniorrhaphy: a randomized, prospective study

Area of Science:

• General Surgery
• Surgical Innovation

Background:

• Long-term recurrence rates for Lichtenstein mesh and Shouldice hernia repairs are low.
• Short-term outcomes may influence surgical repair choice.
• No prospective studies have compared short-term morbidity between mesh and Shouldice repairs.

Purpose of the Study:

• To prospectively compare the short-term morbidity of Lichtenstein mesh versus Shouldice inguinal hernia repair.
• To evaluate differences in postoperative pain, narcotic use, and recovery time.

Main Methods:

• 105 adult patients were randomized to undergo either mesh or Shouldice inguinal hernia repair.
• Postoperative pain, narcotic use, and time to resume activities/employment were recorded.
• Patients were blinded to the repair type until data collection concluded.

Main Results:

• No significant differences were observed between mesh and Shouldice repairs regarding postoperative pain, narcotic use, or time to resume usual activities and employment.
• Both groups experienced rapid recovery, with 50% reporting mild pain and no longer needing narcotics by postoperative day 3.
• A median of 9 days was required for patients in both groups to return to usual activity and work.

Conclusions:

• Both Lichtenstein mesh and Shouldice repairs are effective for inguinal hernias with minimal short-term morbidity when performed with local anesthesia in an outpatient setting.
• Despite the tension-free design of mesh repair, short-term outcomes are comparable to the Shouldice method.