Dr Vivek Kumar Singh, Dr Nitu Singh


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.


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

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