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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
Review/Meta-analysis

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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.

Keywords

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

Notes

Acknowledgments

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.

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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

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