The Shouldice repair – experience with first 50 patients

Abstract

Background: Shouldice repair (SR) is tissue or tension repair for inguinal hernia. In spite of widespread use of mesh prostheses for inguinal hernia, SR still has an important place in herniology. Relatively rare use of SR is partly a consequence of the outbreak of mesh-techniques, but partly also of more demanding surgical technique. In developped contries, SR is included in guidelines of many countries for patients under 30 years of age. SR is also indicated in patients older than 30 years who have a small or medium-sized indirect inguinal hernia. Patients and methods: In a 4-year period (1 January 2006 – 31 December 2009) we operated on first 50 patients with inguinal hernia. Considering the learning curve for SR, selection of patients was performed preoperativelly including patients with small indirect or direct and medium sized indirect inguinal hernia (H1, H2). Results: The average age of patients was 38.2 years (18–60 years). Two thirds of SRs were performed under general anaesthesia, one fourth under spinal anaesthesia and the last tenth of SR‘s under local anaesthesia. The average operating time was 46.2 minutes. The vast majority (45 pts–90 %) of SRs were performed using polypropylene suture, in 5 patients (10 %) we used steel wire. SRs were performed by 5 different surgeons, whereby 1 surgeon performed 45 (90 %) of all repairs. The duration of hospitalisation was 2 days after the repair for 40 patients (80 %), 1 day for 5 patients (10 %) and 3 days for 2 patients (4 %). Three patients (6 %) were day-hospital patients. Postoperative pain on day 1 was the same (VAS 4) comparing SR with tension-free repairs, with the exception of learning curve patients, where the skin incision was up to 2 cm longer for better presentation of anatomy (VAS 5–7). In the current follow-up of patients after SR (2–5 yrs, telephonic inquiry), we have not observed any chronic pain or recurrence. Conclusions: SR is the most effective hernia operation among tissue repairs. Very few complications such as chronic pain or recurrence are observed in its use. Our first experience is very good and considering indications, further use of SR in Slovenia is recommended. With due regard for the individual steps of SR as described, we may expect comparably good results as those reported by the authors abroad. Further follow-up of the patients is required.