COMPARATIVE STUDY OF SHOULDICE'S AND LICHTENSTEIN'S METHOD OF INGUINAL HERNIA REPAIR IN AGE GROUPS LESS THAN AND MORE THAN 50 YEARS

Dr Vivek Kumar Singh, Dr Nitu Singh

Abstract


Introduction: Lichtenstein introduced the “tension free repair,” with primary repair of the floor of inguinal canal using a polypropylene mesh and has become gold standard of inguinal hernia repair today. However, in a developing country like ours, affordability of mesh repair is difficult for many poor patients. In good hands, Shouldice’s anatomical repair has a very low recurrence rate. Therefore, a study was done at a tertiary hospital to compare both the techniques in term of their recurrence, efficacy, post op pain, complications in age group less than and more than 50 years.

Material and methods: This was a prospective, longitudinal, cohort study of 100 cases of inguinal hernia, which were randomly distributed into two groups of Shouldice’s repair and Lichtenstein’s repair in the age groups of 18-50 years and more than 50 years. This study was carried out on patients attending a tertiary care hospital for a period for 2 years. Data was collected in regarding ease to perform the surgery, postoperative pain, intra operative complications and bleeding, immediate postoperative complication.

Results: In Shouldice’s repair group, two patients had injury to the epigastric vessels while incising the transversalis fascia in the posterior wall of inguinal canal. One patient had injury to the ilioinguinal nerve in Lichtenstein’s group while fixing the mesh to the inguinal ligament. The average difficulty of performing the surgery in Shouldice’s repair group was 4.28 and in Lichtenstein’s repair group was 3.46. In this study most patients were followed up for assessing recurrence over 08 months to 18 months. This study showed recurrence of 2 cases (8%) in Shouldice’s repair group in age group more than 50 yrs and nil cases in Lichtenstein’s repair group. Among the 2 cases, one patient had irreducible hernia, in whom anatomical dissection was difficult and repair was under tension. Overall recurrence in all age group in Sholudice’s was 4% and nil in Lichetenstein’s group.

Discussion: The Shouldice technique required considerable time to learn and difficulties were sometimes met when trying to accomplish repair at the inguinal floor without tension. The recurrence rate in Shouldice’s group was 4% in all age group, while Lichtenstein’s had none.

To conclude, in ever evolving era of inguinal hernia repair, Lichtenstein inguinal hernia repair has now become a gold standard in all age group with lesser morbidity and excellent patient outcome. However, it can be emphasized that Shouldice’s repair still holds good in a developing country like India, due to its cost effectiveness.

Keywords


Inguinal hernia, Lichtenstein's repair, Shouldice's repair

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References


Cooper AP: The Anatomy and Surgical Treatment of Abdominal Hernia (2 Vols). London, Longmans, 1804, 1807

Nilsson E, Haapaniemi S, Gruber G, Sandblom G. Methods of repair and risk for reoperation in Swedish hernia surgery from 1992 to 1996. Br J Surg 1998; 85: 1686±91.

Johanet H, Cossa JP, Marmuse JP, Benhamou G. Cure de hernie de l'aine par laparoscopie. ReÂsultats a quatre ans de la voie transpreÂpeÂritoneÂale. Ann Chir 1995; 50: 790±4.

Glassow F. The Shouldice Hospital technique. Int Surg 1986; 71: 148±53.

Devlin HB, Gillen PHA, Waxman BP, MacNay RA. Short stay surgery for inguinal hernia: experience of the Shouldice operation, 1970±1982. Br J Surg 1986; 73: 123±4.

Bendavid R. The Shouldice technique: a canon in hernia repair. Can J Surg 1997; 40: 199±207.

Shulman AG, Amid PK, Lichtenstein IL. A survey of non-expert surgeons using the open tension-free mesh patch repair for primary inguinal hernias. Int Sur 1995; 80: 35±6.

James E. McGillicuddy, MD, Prospective Randomized Comparison of the Shouldice and Lichtenstein Hernia Repair Procedures. Arch Surg. 1998; 133:974-978.http//www. archives of surgery.com Accessed 08 Nov 2008.

P. Nordin, P. Bartelmess, C. Jansson, C. Svensson and G. Edlund. Department of Surgery, Ostersund Hospital, S-831 83 Ostersund, Sweden. Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice. http//www.bjs.co.uk, 2002, 89, 45-49.

Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM. Department of Public Health, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, UK, AB25 2ZD. Open mesh versus non-mesh for repair of femoral and inguinal hernia. n.w.scott@abdn.ac.uk.

Danielsson P, Isacson S, Hansen MV. Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training. Eur J Surg, 1999; 165: 49±53.

EUHernia Trialists Collaboration. Mesh compared with nonmesh methods of open groin hernia repair: systematic review of randomized controlled trials. Br J Surg 2000; 87: 854±9.

Vrijland, W.W., et al., Randomized clinical trial of non-mesh versus mesh repair of primary of primary inguinal hernia, http//www.bjs.co.uk, 2002. 89(3): p. 293-7.

Berndsen, F, and Sevonius, Changing the path of inguinal hernia surgery decreased the recurrence rate tenfold. Report from a country hospital. Eur J Surg, 2002, 168(11): p. 592-6.

Bay-Nielson, M., ey al., Convalescence after inguinal herniorrhaphy, Br J Surg, 2004, 91(3): p. 362-7.

Bendavid R. New techniques in hernia surgery. World J Surg. 1989; 13:522-531.

Morfesis FA. The recurrence rate in hernia surgery. Arch Surg. 1996; 131:107.


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