Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials

  • R. Bittner
  • S. Sauerland
  • C.-G. Schmedt



We performed a scientific evaluation of the efficacy of different surgical techniques for inginual hernia repair and supported our findings by conducting a systematic review of randomized studies comparing endoscopic with open nonmesh suture techniques.


After an extensive search of the literature, a total of 27 studies (41 publications) with evidence level lb were identified. These studies randomly compared endoscopic with open nonmesh suturing techniques. The quality of data sufficed to enable a quantitative meta-analysis of various parameters using the original software of the Cochrane Collaboration. Due to its superiority in comparison to other open nonmesh suturing techniques, the Shouldice repair technique was analyzed separately.


The systematic comparison of endoscopic techniques with the Shouldice repair showed that these techniques had significant advantages in terms of the following parameters: total morbidity, hematoma, nerve injury, and pain-associated parameters such as time to return to work, and chronic groin pain. The Shouldice operation has the advantages of a shorter operating time and a lower incidence of wound seroma. There was no difference regarding the incidence of major complications, wound infection, testicular atrophy, or hernia recurrence. Open non-Shouldice suturing techniques are associated with higher recurrence rates and more wound infections than endoscopic operations.


In comparison to open nonmesh suture repair techniques, endoscopic repair techniques have significant advantages in terms of pain-associated parameters. For the revaluation of long-term complications such as hernia recurrence and chronic groin pain, further clinical examination of the existing study collectives is needed.


Groin Hernia, surgery Laparoscopy Randomized trial Evidence-based medicine Review 



We thank the following members of Workgroup 8 of the Consensus Conference on Hernia Surgery, 28–30. November 2002, Magdeburg, Germany, for their support: K. H. Bauer (Bochum), D. Birk (Zweibruecken), H. Keller (Donaueschingen), T. Manger (Gera), G. Meyer (Munich), and C. Peiper (Witten). Thanks also go to A. Hollins for translating the manuscript.


Meta-analyses/Reviews [Ia]

  1. 1.
    McCormack K, Scott NW, Go PMNYH, Ross S, Grant AM, EU Hernia Trialists Collaboration (2003) Laparoscopic versus open techniques for inguinal hernia repair (Cochrane review). In: The Cochrane Library, Issue 4. Wiley, Chichester. (UK).Google Scholar
  2. 2.
    Grant, AM Hernia EU Trialists Collaboration2002Laparoscopic versus open groin hernia repair: meta-analysis of randomised trials based on individual patient dataHernia6210European Hernia Trialists CollaborationPubMedGoogle Scholar
  3. 3.
    EU Hernia Trialists Collaboration2002Repair of groin hernia with synthetic mesh: metaanalysis of randomized controlled trialsAnn Surg235322332Google Scholar
  4. 4.
    EU Hernia Trialists Collaboration2000Laparoscopic compared with open methods of groin hernia repair: systematic review of randomized controlled trialsBr J Surg87860867Google Scholar

Other meta-analyses/Reviews

  1. 5.
    Stylopoulos, N, Gazell, GS, Rattner, DW 2003A cost-utility analysis of treatment options for inguinal hernia in 1,513,008 adult patientsSurg Endosc17180189PubMedGoogle Scholar
  2. 6.
    Voyles, CR, Hamilton, BJ, Johnson, WD, Kano, N 2002Meta-analyses of laparoscopic inguinal hernia trials favors open hernia repair with perperitoneal mesh prosthesisAm J Surg184610PubMedGoogle Scholar
  3. 7.
    Schmedt, CG, Leibl, BJ, Bittner, R 2002Endoscopic inguinal hernia repair in comparison with Shouldice and Lichtenstein repair: a systematic review of randomized trialsDig Surg19511517PubMedGoogle Scholar
  4. 8.
    Fingerhut, A, Millat, B, Bataille, N, Yachouchi, E, Dziri, C, Boudet, MJ, Paul, A 2001) Laparoscopic hernia repair in 2000: update of the European Association for Endoscopic Surgery (E.A.E.S) consensus conference in Madrid, June 1994Surg Endosc1510611065PubMedGoogle Scholar
  5. 9.
    Leibl, BJ, Schmedt, CG, Ulrich, M, Kraft, K, Bittner, R 1999Laparoscopic hernia repair—the facts, but no fashion LangenbecksArch Surg384302311Google Scholar
  6. 10.
    Chung, RS, Rowland, DY 1999Meta-analyses of randomized controlled trials of laparoscopic vs conventional inguinal hernia repairsSurg Endosc13689694PubMedGoogle Scholar
  7. 11.
    Cheek, CM, Black, NA, Devlin, HB, Kingsnorth, AN, Taylor, RS, Watkin, DFL 1998Groin hernia surgery: a systematic reviewAnn R Coll Surg Engl80xxxxGoogle Scholar
  8. 12.
    Krähenbühl, L, Schäfer, M, Feodorovici, MA, Büchler, MW 1998Laparoscopic, hernia surgery: an overviewDig Surg15158166PubMedGoogle Scholar
  9. 13.
    Go PMNYH1998Overview of randomized trials in laparoscopic inguinal hernia repairSemin Laparosc Surg5238241Google Scholar
  10. 14.
    Macintyre, IMC, Miles, WFA 1995Critical appraisal and current position of laparoscopic hernia repairJ R Coll Surg Edinb40 331336Google Scholar
  11. 15.
    MacFadyen, BV,Jr, Mathis, CR 1994Inguinal herniorrhaphy: complications and recurrencesSemin Laparosc Surg1128140PubMedGoogle Scholar

Included Studies TAPP/TEP vs Shouldice repair: randomized trials [Ib]

  1. 16.
    Tschudi, JF, Wagner, M, Klaiber, C, Brugger, J-J, Frei, E, Krähenbühl, L, Inderbitzi, R,  et al. 2001Randomized controlled trial of laparoscopic transabdominal preperitoneal hernioplasty vs Shouldice repairSurg Endosc1512631266Aarberg 1996PubMedGoogle Scholar
  2. 17.
    Tschudi, JF, Wagner, M, Klaiber, C, Brugger, J-J, Frei, E, Krähenbühl, L, Inderbitzi, R,  et al. 1996Controlled multicenter trial of laparoscopic transabdominal preperitoneal herniorrhaphSurg Endosc10845847PubMedGoogle Scholar

Berlin 1996

  1. 18.
    Zieren, J, Zieren, HU, Jacobi, CA, Wenger, FA, Müller, JM 1998Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’s operationAm J Surg175330333PubMedGoogle Scholar
  2. 19.
    Zieren, J, Zieren, HU, Said, S, Müller, JM 1996Laparoscopic or conventional inguinal hernia repair with or without implant. A prospective randomized study Langenbecks Arch Chir Suppl Kongressbd113609610PubMedGoogle Scholar

Bietigheim 1998

  1. 20.
    Köninger, JS, Oster, M, Butters, M 1998Leistenhernienversorgung — ein Vergleich gängiger VerfahrenChirurg6913401344PubMedGoogle Scholar

Bonn 1999

  1. 21.
    Decker, D, Lindemann, C, Springer, W, Low, A, Hirner, A, Ruecker, A 1999Endoscopic versus conventional hernia repair from immunologic point of viewSurg Endosc13335339PubMedGoogle Scholar

Brisbane 1996

  1. 22.
    Nathanson, L, Adib, R, Braniki, F 1996Randomized trial of open and laparoscopic inguinal hernia repair [Abstract]Surg Endosc10192Google Scholar

Caen 1998

  1. 23.
    Damamme, A, Samama, G, D’Alche-Gautier, MJ, Chanavel, N, Bréfort, JL, Le Roux, Y 1998Evaluation médico-économique de la cure de hernie inguinale: Shouldice vs laparoscopieAnn Chir521116PubMedGoogle Scholar

Linköping 1997

  1. 24.
    Kald, A, Anderberg, B, Carlsson, P, Park, PO, Smedh, K 1997Surgical outcome and cost-minimisation analyses of laparoscopic and open hernia repair: a randomized prospective trial with one year follow-upEur J Surg163505510PubMedGoogle Scholar

Linz 1996

  1. 25.
    Schrenk, P, Woisetschläger, R, Rieger, R, Wayand, W 1996Prospective randomized trial comparing postoperative pain and return to physical activity after transabdominal preperitoneal, total preperitoneal or Shouldice technique for inguinal hernia repairBr J Surg8315631566Google Scholar
  2. 26.
    Schrenk, P, Bettelheim, P, Woisetschläger, R, Rieger, R, Wayand, WU 1996Metabolic responses after laparoscopic or open hernia repairSurg Endosc10628632PubMedGoogle Scholar

Mannheim 2000

  1. 27.
    Lorenz, D, Stark, E, Oestreich, K, Richter, A 2000Laparoscopic hernioplasty versus conventional hernioplasty (Shouldice): results of a prospective randomized trialWorld J Surg24739746PubMedGoogle Scholar

Melbourne 2001

  1. 28.
    Fleming, WR, Elliott, TB, Jones, RM, Hardy, KJ 2001Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice techniqueBr J Surg8811831188Google Scholar

Nyborg 1999

  1. 29.
    Juul, P, Christensen, K 1999Randomized clinical trial of laparoscopic versus open inguinal hernia repairBr J Surg86316319Google Scholar

Paris1 1994

  1. 30.
    Champault, G, Benoít, J, Lauroy, J, Rizk, N, Boutelier, P 1994Hernies de l’aine de l’adultel: chirurgie laparoscopique vs opération de ShouldiceAnn Chir4810031008PubMedGoogle Scholar
  2. 31.
    Benoit, J, Champault, G, Lauroy, J, Rizk, N, Boutelier, P 1994Traitement laparoscopique des hernies de l’aine: evaluation de la douleur postoperatoire: voie pre-peritoneal pure vs operation de ShouldiceChirurgie120455459PubMedGoogle Scholar
  3. 32.
    Rizk, N, Champault, G, Lauroy, J, Benoit, J, Boutelier, P 1994Laparoscopic preperitoneal hernia repair vs Shouldice herniorrhaphy: preliminary results of a prospective randomized trial of 242 casesBr J Surg 81.7071Google Scholar

Paris2 1997

  1. 33.
    Champault, G, Barrat, C, Catheline, JM, Rizk, N 1998Hernies de l’aine: résultats à 4 ans de deux études prospectives randomisées comparant les opérations de Shouldice et de Stoppa à l’abord laparoscopique totalement pré-péritiónealAnn Chir52132136PubMedGoogle Scholar
  2. 34.
    Champault, GG, Rizk, N, Catheline, JM, Turner, R, Boutelier, P 1997Inguinal hernia repair. Totally preperitoneal laparoscopic approach versus stoppa operation: Randomized trial of 100 casesSurg Laparosc Endosc7445450PubMedGoogle Scholar
  3. 35.
    Champault, G, Rizk, N, Catheline, JM, Riskalla, H, Boutelier, P 1996Groin hernia: pre-peritoneal laparoscopic sugery versus open (Stoppa) procedure. Prospective randomized trial: 100 casesJ Chir (Paris)133274280Google Scholar

Stuttgart 1995

  1. 36.
    Leibl, BJ, Däubler, P, Schmedt, CG, Kraft, K, Bittner, R 2000Long-term results of a randomized clinical trial between laparoscopic hernioplasty and Shouldice repairBr J Surg87780783Google Scholar
  2. 37.
    Leibl, BJ, Däubler, P, Schwarz, J, Ulrich, M, Bittner, R 1995Standardisierte laparoskopische Hernioplastik vs. Shouldice-RepairChirurg66895898PubMedGoogle Scholar

Swedish Multicenter 2002

  1. 38.
    Berndsen, F, Arvidsson, D, Enander, LK, Leijonmarck, CE, Wingren, U, Rudberg, C, Smedberg, S,  et al. 2002Postoperative convalescence after inguinal hernia surgery: prospective randomized multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1042 patientsHernia65661PubMedGoogle Scholar

Tournai 1996

  1. 39.
    Hauters, P, Meunier, D, Urgyan, S, Jouret, JC, Janssen, P, Nys, JM 1996Etude prospective controlée comparant laparoscopie et Shouldice dans le traitement de la hernie inguinale unilatéraleAnn Chir50776781PubMedGoogle Scholar

Ulm 1993

  1. 40.
    Kunz, R, Schwarz, A, Beger, HG 1993Laparoscopic transperitoneal hernia repair versus Shouldice herniorrhaphy: preliminary results of a prospectively randomised trialChir Endosc71213Google Scholar
  2. 41.
    Kunz, R, Schwarz, A, Beger, HG 1994Laparoscopic inguinal (TAPP) hernioplasty versus Shouldice hernioplasty: preliminary results of a prospectively randomized study [Abstract]Surg Endosc8485Google Scholar

Woodville 1996

  1. 42.
    Bessell, JR, Baxter, P, Riddell, P, Watkin, S, Maddern, GJ 1996A randomized controlled trial of laparoscopic extraperitoneal hernia repair as a day surgical procedureSurg Endosc10495500PubMedGoogle Scholar

Included studies TAPP/TEP vs open non-Shouldice suture repair: [Ib]

  1. 43.
    Rudkin, GE, Maddern, GJ 1995Peri-operative outcome for day-case laparoscopic and open inguinal hernia repairAnaesthesia50586589Adelaide 1994PubMedGoogle Scholar
  2. 44.
    Maddern, GJ, Rudkin, G, Bessell, JR, Devitt, P, Ponte, L 1994A comparison of laparoscopic and open hernia repair as a day surgical procedureSurg Endosc814041408PubMedGoogle Scholar

Bankok 1998

  1. 45.
    Tanphiphat, C, Tanprayoon, T, Sangsubhan, C, Chatamra, K 1998Laparoscopic vs-open inguinal hernia repair: a randomized, controlled trialSurg Endosc12846851PubMedGoogle Scholar

Coala Trial Group 1997

  1. 46.
    Liem, MSL, Graaf, Y, Steensel, CJ, Boelhouwer, RU, Clevers, WF, Schrijvers, AJP, Vroonhoven, TJMV 1997Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repairN Engl J Med33615411547PubMedGoogle Scholar
  2. 47.
    Liem, MSL, Halsema, JAM, Graaf, Y, Schrijvers, AJP, Vroonhoven, TJMV 1997Cost-effectiveness of extraperitoneal laparoscopic inguinal hernia repair: a randomized comparison with conventional herniorrhaphyAnn Surg226668676CrossRefPubMedGoogle Scholar
  3. 48.
    Liem, MSL, Graaf, Y, Zwart, RC, Geurts, I, Vroonhoven, TJMV 1997A randomized comparison of physical performance following laparoscopic and open inguinal hernia repairBr J Surg846467Google Scholar

Konya 2002

  1. 49.
    Vatansev, C, Belviranli, M, Aksoy, F, Tuncer, S, Sahin, M, Karahan, O 2002The effects of different hernia repair methods on postoperative pain medication and CRP levelsSurg Laparosc Endosc Percutan Tech12243246PubMedGoogle Scholar

Maastricht1 1998

  1. 50.
    Dirksen, CD, Beets, GL, Go, PMNYH, Geisler, GEA, Baeten, CGMI, Kootstra, G 1998Bassini repair compared with laparoscopic repair for primary inguinal hernia: a randomized controlled trialEur J Surg164439446PubMedGoogle Scholar

Oxford 1995

  1. 51.
    Lawrence, K, McWhinnie, D, Jenkinson, C, Coulter, A 1997Quality of life in patients undergoing inguinal hernia repairAnn R Coll Surg Engl794045Google Scholar
  2. 52.
    Lawrence, K, McWhinnie, D, Goodwin, A, Gray, A, Gordon, J, Storie, J, Britton, J, Collin, J 1996An economic evaluation of laparoscopic versus open inguinal hernia repairJ Public Health Med184148PubMedGoogle Scholar
  3. 53.
    Lawrence, K, McWhinnie, D, Goodwin, A, Gray, A, Gordon, J, Storie, J, Britton, J,  et al. 1995Randomized controlled trial of laparoscopic versus open repair of inguinal hernia: early resultsBMJ311981985PubMedGoogle Scholar

SCUR 1997

  1. 54.
    Johansson, B, Hallerbäck, B, Glise, H, Anesten, B, Smedberg, S, Román, J 1999Laparoscopic versus open preperitoneal mesh versus conventional technique for inguinal hernia repair: a randomized multicenter trial (SCUR Hernia Repair Study)Ann Surg230225231PubMedGoogle Scholar
  2. 55.
    Johansson, B, Hallerbäck, B, Glise, H, Anesten, B, Melen, K, Holm, J, Bergmann, B 1997Laparoscopic versus open repair W/WO mesh graft for inguinal hernia repair: (SCUR Hernia Repair Study)Surg Endosc11170[abstract]Google Scholar

Thessaloniki 2002

  1. 56.
    Pavlidis, TE, Atmatzidis, KS, Lazaridis, CN, Papaziogas, BT, Makris, JG, Papaziogas, TB 2002Comparison between modern mesh and conventional mesh methods of inguinal hernia repairMinerva Chir57712PubMedGoogle Scholar

Whipps Cross1 1994

  1. 57.
    Stoker, DL, Spiegelhalter, DJ, Singh, R, Wellwood, JM 1994Laparoscopic versus open inguinal hernia repair: randomised prospective trialLancet34312431245PubMedGoogle Scholar

Excluded studies

  1. 58.
    Akhtar, K, Kamalky-asl, ID, Lamb, WR, Laing, I, Walton, L, Rearson, RC, Rarrott, NR 1998Metabolic and inflammatory responses after laparoscopic and open inguinal hernia repairAnn R Coll Surg Engl80125130PubMedGoogle Scholar
  2. 59.
    Angelescu, N, Jitea, N, Burcos, T, Cristian, D, Voiculescu, S, Dimitriu, C 1998The classical or laparoscopic operation in inguinal herniasChirurgia (Bucur)93213216Google Scholar
  3. 60.
    Angelescu, N, Jitea, N, Burcos, T, Cristian, D, Voiculescu, S, Dimitriu, C 1996A comparative study of the laparoscopic and classic treatments of inguinal herniasChirurgia (Bucur)45267270Google Scholar
  4. 61.
    Barkun, JS, Keyser, EJ, Wexler, MJ, Fried, GM, Hinchey, EJ, Fernandez, M, Meakins, JL 1999Short-term outcomes in open vs. laparoscopic herniorrhaphy: confunding impact of workers compesation on convalescenceJ Gastrointest Surg3575582PubMedGoogle Scholar
  5. 62.
    Barkun, JS, Wexler, MJ, Hinchey, EJ, Thibeault, D, Meakins, JL 1995Laparoscopic versus open inguinal herniorrhayphy: preliminary results of a randomized controlled trialSurgery118703710PubMedGoogle Scholar
  6. 63.
    Bay-Nielsen, M Kehelet, H Strand, L Malmstrom, J Andersen, FH Wara, P Juul, P Danish Hernia Database Collaboration et al. 2001Quality assessment of 26304 herniorrhaphies in Denmark: a prospective nationwide studyLancet35811241128CrossRefPubMedGoogle Scholar
  7. 64.
    Bay-Nielsen, M Perkins, FM Kehlet, H Danish Hernia Database Collaboration2001Pain and functional impairment 1 year after inguinal herniorrhapny: a nationwide questionnaire studyAnn Surg23317PubMedGoogle Scholar
  8. 65.
    Cornell, RB, Kerlakian, GM 1994Early complications and outcomes of the current technique of transperitoneal laparoscopic herniorrhaphy and a comparison to the traditional open approachAm J Surg168275279PubMedGoogle Scholar
  9. 66.
    Dirksen, CD, Ament, AJ, Adang, EM, Beets, GL, Go, PM, Baeten, CGMI, Kootstra, G 1998Cost-effectiveness of open versus laparoscopic repair for primary inguinal herniaInt J Technol Assess Health Care14472483PubMedGoogle Scholar
  10. 67.
    Eno, LM, Spigelman, AD 2000An audit of open and laparoscopic inguinal hernia repairJ Qual Clin Pract205659PubMedGoogle Scholar
  11. 68.
    Ferzli, G, Massaad, A, Albert, P, Worth, MH 1993Endoscopic extraperitoneal herniorrhaphy versus conventional hernia repair: a comparative studyCurr Surg50291294Google Scholar
  12. 69.
    Gillon, JF, Fagniez, PL 1999Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniquesHernia37580Google Scholar
  13. 70.
    Haug-Gebhard, S, Becker, HP, Ehrlich, R, Thiede, P, Gerngroß, H 1996Comparison of endoscopic exteperitoneal and conventional hernia repairLangenbecks Arch Chir Suppl Kongressbd113611613PubMedGoogle Scholar
  14. 71.
    Hill, AD, Banwell, PE, Darzi, A, Menzies-Gow, N, Monson, JR, Guillou, PJ 1995Inflammatory markers following laparoscopic and open hernia repairSurg Endosc9695698PubMedGoogle Scholar
  15. 72.
    Janu, PG, Sellers, KD, Mangiate, EC 1997Mesh inguinal herniorraphy: a ten-year reviewAm Surg6310651069PubMedGoogle Scholar
  16. 73.
    Kald, A, Fridsten, S, Nordin, P, Nilsson, E 2002Outcome and repair of bilateral groin hernias: a prospective evaluation of 1487 patientsEur J Surg168150153PubMedGoogle Scholar
  17. 74.
    Kozol, R, Lange, PM, Kosir, M, Beleski, K, Mason, K, Tennenberg, S, Kubinec, SM,  et al. 1997A prospective, randomized study of open vs laparoscopic inguinal hernia repair: an assessment of postoperative painArch Surg132292295PubMedGoogle Scholar
  18. 75.
    Krähenbühl, L, Schäfer, M, Schilling, M, Kuzinkovas, V, Büchler, MW 1998Simultaneous rapair of bilateral inguinal hernias: open or laparoscopic approach?Surg Endosc8313318Google Scholar
  19. 76.
    Lukaszczyk, JJ, Preletz, RJ, Morrow, GJ, Lange, MK, Tachovsky, TJ, Krall, JM 1996Laparoscopic herniorrhaphy versus traditional open repair at a community hospitalJ Laparoendosc Surg6203208PubMedGoogle Scholar
  20. 77.
    McIntosh, E, Donaldson, C, Grant, A 1998Economic evaluation of open versus laparoscopic hernia repair: some pragmatic considerations for measurement of costsSemin Laparosc Surg5242247PubMedGoogle Scholar
  21. 78.
    Millikan, KW, Kosik, ML, Doolas, A 1994A prospective comparison of transabdominal preperitoneal laparoscopic hernia repair versus traditional open hernia repair in a university settingSurg Laparosc Endosc4247253PubMedGoogle Scholar
  22. 79.
    Nicholson, T, Tiruchelvam, V 1999Comparison of laparoscopic vs open modified Shouldice technique in inguinal hernia repairJSLS33943PubMedGoogle Scholar
  23. 80.
    Perniceni, T, Danes, M, Boudet, MJ, Levard, H, Gayet, B 1998Laparoscopy versus the Shouldice intervention in the treatment of unilateral inguinal hernia: can the operative surcosts be minimized?Gastroenterol Clin Biol2210611064PubMedGoogle Scholar
  24. 81.
    Savarise, MT, Simpson, JP, Moore, JM, Leis, VM 2001Improved functional outcome and more rapid return to normal activity following laparoscopic hernia repairSurg Endosc15574578PubMedGoogle Scholar
  25. 82.
    Schultz, LS 1998Laparoscopic versus inguinal hernia repairs: outcome and costsSurg Endosc913071311Google Scholar
  26. 83.
    Stengel, D, Lange, V 1998Quality of life after inguinal hernia operation: results of a prospective study (Shouldice, Lichtenstein, TAPP)Langenbecks Arch Chir Suppl Kongressbd11510201023PubMedGoogle Scholar
  27. 84.
    Sheppard, BC 1993Minimal access versus open herniorrhaphyWorld J Med159685686Google Scholar
  28. 85.
    Takahara, T, Uyama, I, Ogiwara, H, Furuta, T, lida, S 1995Inflammatory responses in open versus laparoscopic herniorrhaphyJ Laparoendosc Surg5317326PubMedGoogle Scholar
  29. 86.
    Vale, L, McCormack, K, Scott, N (2001) The effectiveness and cost effectiveness of laparoscopic compared to open surgery for inguinal hernia repair. Report commissioned by National Institute of Clinical Effectiveness, January 2001. Available online at:
  30. 87.
    Vogt, DM, Curet, MJ, Pitcher, DE, Martin, DT, Zucker, KA 1995Preliminary results of a prospective randomized trial of laparoscopic onlay versus conventional inguinal herniorrhaphyAm J Surg1698490PubMedGoogle Scholar

Further references

  1. 88.
    Bassini, E 1889Nuovo metodo operativo per la cura radicale dell’ernia inguinaleStabilimento ProsperiniPadovaGoogle Scholar
  2. 89.
    Bittner, R 2003Results of the Magdeburg Consensus Conference on Surgical Hernia RepairZentralbl Chir128549550PubMedGoogle Scholar
  3. 90.
    Bittner, R, Schmedt, C-G, Schwarz, J, Kraft, K, Leibl, BJ 2002Laparoscopic transperitoneal procedure for routine repair of groin herniaBr J Surg8910621066PubMedGoogle Scholar
  4. 91.
    Feliu-Pala, X, Martín-Gómez, M, Morales-Conde, S, Fernández-Sallent, E 2001The impact of the surgeon’s experience on the results of laparoscopic hernia repairSurg Endosc1514671470PubMedGoogle Scholar
  5. 92.
    Lichtenstein, IL, Shulman, AG, Amid, PK, Montllor, MM 1989The tension-free hernioplastyAm J Surg157188193PubMedGoogle Scholar
  6. 93.
    Neumayer, L, Jonasson, O, Fitzgibbons, R, Henderson, W, Gibbs, J, Carrico, CJ, Itani, K,  et al. 2003Tension-free inguinal hernia repair: the design of a trial to compare open and laparoscopic surgical techniquesJ Am Coll Surg196743752PubMedGoogle Scholar
  7. 94.
    Occelli, G, Barrat, C, Catheline, JM, Voreux, JP, Cueto-Rozon, R, Champault, G 2000Laparoscopic treatment of inguinal hernias: prospective evaluation of 757 cases treated by a totally extraperitoneal routeHernia48184Google Scholar
  8. 95.
    Ramshaw, B, Shuler, FW, Jones, HB, Duncan, TD, White, J, Wilson, R, Lucas, GW,  et al. 2001Laparoscopic inguinal hernia repair: lessons learned after 1224 consecutive casesSurg Endosc155054PubMedGoogle Scholar
  9. 96.
    Schmedt CG, Sauerland S, Bittner R (2004) Comparison of endoscopic techniques versus Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized trials. Surg Endosc 19: 188–199PubMedGoogle Scholar
  10. 97.
    Schumpelick, V, Arlt, G, Schlachetzki, A, Klosterhalfen, B 1998Chronic incuinal pain after transperitoneal mesh implantation: Case report of net shrinkageChirurg6812971300Google Scholar
  11. 98.
    Scott NW, McCormack K, Graham P, Go PMNYH, Ross SJ, Grant AM, EU Hernia Trialists Collaboration (2003) Open mesh versus non-mesh for groin hernia repair (Cochrane Review). In: The Cochrane Library, Issue 4. Wiley, Chichester (UK) Google Scholar
  12. 99.
    Shouldice, EE 1945Surgical treatment of herniaOntario Med Rev443Google Scholar
  13. 100.
    Simons, MP, Kleijnen, J, Geldere, D, Hoitsma, HF, Obertop, H 1996Role of Shouldice technique in inguinal hernia repair: a systematic review of controlled trials and a meta-analysisBr J Surg83734738Google Scholar
  14. 101.
    Schultz, C, Baca, I, Götzen, V 2001Laparoscopic inguinal hernia repairSurg Endosc15582584PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  1. 1.Department of General SurgeryMarienhospital StuttgartGermany
  2. 2.Biochemical and Experimental Division, 2nd Department of SurgeryUniversitiy of CologneGermany
  3. 3.Department of SurgeryUniversity of MunichGermany

Personalised recommendations