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

Abstract

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. During 3years, 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 18years. The follow-up met the nine quality criteria proposed by the authors. At 18years, 80.2% of patients were followed and only 6.5% were lost. There were 7 recurrences in the first 10years, 5 of them secondary to a direct hernia, and the same after 18years. The recurrence rate was 2.88%. Tolerance of the local anesthesia was excellent in 91.4%of patients and, after 3years, the pain was considered moderate or severe in 4 patients (1.8%). 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 30years 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.