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Results of Shouldice hernia repair after 18 years of follow-up in all the patients

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Abstract

Purpose

Evaluate the long-term efficacy of the Shouldice technique performed by non-specialized surgeons and also to reflex on the quality parameters necessary to safely assess hernia recurrence rates.

Methods

During 3 years, a prospective study was conducted in 243 adult men who underwent surgery for primary inguinal hernias by 13 junior surgeons with an interest in hernia surgery. Using local anesthesia, a classic 4 step Shouldice repair, with polypropylene or polyester, was performed. All patients were followed for 18 years. The follow-up met the nine quality criteria proposed by the authors.

Results

At 18 years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10 years, 5 of them secondary to a direct hernia, and the same after 18 years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3 years, the pain was considered moderate or severe in 4 patients (1.8%).

Conclusions

It is necessary to incorporate more demanding criteria in the assessment of recurrence, to give more valid results. The Shouldice technique remains a useful technique today not only in patients under 30 years of age, and in the absence of risk factors, but also in cases of intolerance, patient rejection or absence of mesh. In addition, it provides the clinical and economic advantages of being possible to perform it under local anesthesia.

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Acknowledgements

To Berta Bergia MD (TN) for the english revision of the manuscript.

Author information

Authors and Affiliations

  1. Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain

    A. Martín Duce, A. Muriel, S. Villeta & J. Gómez

  2. Department of General Surgery, Príncipe de Asturias University Hospital, Madrid, Spain

    A. Martín Duce

  3. Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain

    O. Lozano & M. Galván

  4. Biostatistics Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Ramón y Cajal University Hospital, Madrid, Spain

    A. Muriel

Authors
  1. A. Martín Duce
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  2. O. Lozano
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  3. M. Galván
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  4. A. Muriel
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  5. S. Villeta
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  6. J. Gómez
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Corresponding author

Correspondence to A. Martín Duce.

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Conflict of interest

We have no conflict of interest to disclose.We have no conflict of interest to disclose.

Ethical approval

The procedures followed were in accordance with the ethical standards of the responsible committee on human rights (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008.

Informed consent

All patients were informed, in the first preoperative consultation and in the first postoperative consultation, upon removal of the stitches, verbally and in writing, by delivering an informative leaflet, that they would be reviewed indefinitely, if they so desired with a view to including them in a group of clinical follow-up of their surgical process. Likewise, they were provided with a direct contact telephone number with the main investigator.

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This article is dedicated to the memory of Dr. Bendavid and Dr. Villeta, great surgeons and excellent human beings.

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Martín Duce, A., Lozano, O., Galván, M. et al. Results of Shouldice hernia repair after 18 years of follow-up in all the patients. Hernia 25, 1215–1222 (2021). https://doi.org/10.1007/s10029-021-02422-8

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  • DOI: https://doi.org/10.1007/s10029-021-02422-8

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