A comparative study of inguinal hernia repair by Shouldice method vs other methods

Background: Hernia is one of the most common surgical conditions encountered in day to day practice. It is a common problem, more in industrial workers who are doing strenuous work over a long period of time. Any method which reduces the recurrence rate as well as lowers the morbidity and post-operative complication rate, must however be considered superior. The common aim in treatment of hernia is to restore the anatomical integrity of the disrupted tissue, performing a strong repair and to prevent further recurrences. Material and methods: This review was based on the study of 80 selected cases of uncomplicated inguinal hernias treated in our institution by random sampling. All the patients were investigated pre-operative check-up in out-patient clinic for planned surgery. All patients were admitted in our hospital and surgery done under anesthesia (spinal, general, local). All patients in our study received pre-operative antibiotic. In operative technique, the difference lies in the repair of the posterior wall. In the present study comparison of inguinal hernia repair by Shouldice versus other three methods modified Bassini’s repair, pre-peritoneal mesh repair and Lichtenstein tension-free repair had been studied with a regular follow up. The selection of the patients for type of anaesthesia was done on the basis of associated cardiac and respiratory diseases. Results: Out of 80 patients, Shouldice repair was done in 20 patients and other three method of repair was also done in 20 patients each. In present study, wound haematoma occurred in three patients, which may be attributed to the extensive dissection. Seven patients developed wound infection, treated by antibiotics and dressing. Three patients developed scrotal oedema, which was treated by scrotal support and anti-inflammatory agents. Two patients developed urinary retention, relieved by analgesics, hot water bag and ambulation. None of them required catheterization. In the present study we encountered two cases of recurrences (2.5%). Conclusion: In Shouldice repair, double breasting ensures the strong repair. In this method of repair minimal tension on the suture line, so relaxing incision are not necessary. Deep inguinal ring is narrowed in the lateral aspect of the repair. Recurrence rate is remarkably low. But the repair is difficult to perform and extensive dissection required and it takes longer operative time.