R Lorenz1, G Arlt2, J Conze3, R Fortelny4,5, J Gorjanc6, A Koch7, J Morrison8, V Oprea9, G Campanelli10. 1. 3+CHIRURGEN Hernia Center, Klosterstrasse 34/35, 13581, Berlin, Germany. lorenz@3chirurgen.de. 2. Department for General- Visceral and Minimal-Invasive Surgery, Park-Klinik Weissensee, Schönstraße 80, 13086, Berlin, Germany. 3. UM Hernienzentrum Dr. Conze, Arabellastraße 17, 81925, München, Germany. 4. Department of General Surgery, Wilhelminenhospital, Montleartstraße 37, 1160, Vienna, Austria. 5. Medical Faculty, Sigmund Freud University, Freudplatz 3, 1020, Vienna, Austria. 6. Department of Surgery, Krankenhaus der Barmherzigen Brüder, St. Veit an Der Glan, Spitalgasse 26, 9300, St. Veit an der Glan, Austria. 7. Hernia Center Cottbus, Gerhard-Hauptmann-Strasse 15, 03044, Cottbus, Germany. 8. Chatham Kent Health Alliance, 78 Victoria Avenue, Chatham, ON, N7L 3A1, Canada. 9. Department of Surgery, Military Hospital Cluj-Napoca, Strada General Traian Moșoiu 22, Cluj-Napoca, Romania. 10. Department of Surgical Science, University of Insubria, Istituto Clinico Santambrogio, Milano, Italy.
Abstract
INTRODUCTION: For many years the Shouldice technique was the gold standard for inguinal hernia repair. Nowadays mesh repair has been proven to entail better results in randomized trials. Since the first publication 1953 the Repair has been described in detail in many textbooks, articles and You Tube videos. It appears that the original technique is used almost exclusively in the Shouldice Hospital in Thornhill/ Canada and despite the success of the Shouldice Hospital many surgeons inexplicably modify this original technique in their daily practice. In the last couple of years there appears to be an increasing interest in pure tissue repairs for various reasons, often fear of mesh-related pain. The aim of the study was to review the current evidence and to define an updated standard with key principles of the Shouldice repair. METHODS: Because of unpublished evidence regarding many operative details the organizing group decided to create a technical update via a consensus meeting with 13 international designated hernia surgeons from six countries. In preparation of the meeting a review of the current literature regarding Shouldice repair was done by the organizing group. A questionnaire was prepared and sent to all participants before the meeting to get an independent answer on all critical aspects. RESULTS: All questions regarding a detailed standard of the operation technique could be outlined. As result of the consensus meeting the participants have formulated all key-points of preparation/dissection and repair of the Shouldice technique. For 5 of 6 critical technical surgical steps a strong consensus could be defined in the group. There was no consensus among the group regarding the cremaster resection and the ideal indication for Shouldice repair. CONCLUSION: After a 75-year history of the Shouldice repair the technique should continue to merit consideration by all hernia surgeons. After this consensus meeting a clear binding standard of the Shouldice technique for all interested surgeons is proposed.
INTRODUCTION: For many years the Shouldice technique was the gold standard for inguinal hernia repair. Nowadays mesh repair has been proven to entail better results in randomized trials. Since the first publication 1953 the Repair has been described in detail in many textbooks, articles and You Tube videos. It appears that the original technique is used almost exclusively in the Shouldice Hospital in Thornhill/ Canada and despite the success of the Shouldice Hospital many surgeons inexplicably modify this original technique in their daily practice. In the last couple of years there appears to be an increasing interest in pure tissue repairs for various reasons, often fear of mesh-related pain. The aim of the study was to review the current evidence and to define an updated standard with key principles of the Shouldice repair. METHODS: Because of unpublished evidence regarding many operative details the organizing group decided to create a technical update via a consensus meeting with 13 international designated hernia surgeons from six countries. In preparation of the meeting a review of the current literature regarding Shouldice repair was done by the organizing group. A questionnaire was prepared and sent to all participants before the meeting to get an independent answer on all critical aspects. RESULTS: All questions regarding a detailed standard of the operation technique could be outlined. As result of the consensus meeting the participants have formulated all key-points of preparation/dissection and repair of the Shouldice technique. For 5 of 6 critical technical surgical steps a strong consensus could be defined in the group. There was no consensus among the group regarding the cremaster resection and the ideal indication for Shouldice repair. CONCLUSION: After a 75-year history of the Shouldice repair the technique should continue to merit consideration by all hernia surgeons. After this consensus meeting a clear binding standard of the Shouldice technique for all interested surgeons is proposed.
Entities:
Keywords:
Groin hernia; Pure tissue repair; Shouldice repair
Authors: Ferdinand Köckerling; Ralph Lorenz; Martin Hukauf; Henning Grau; Dietmar Jacob; René Fortelny; Andreas Koch Journal: Ann Surg Date: 2019-07 Impact factor: 12.969
Authors: D Weyhe; J Conze; A Kuthe; F Köckerling; B J Lammers; R Lorenz; H Niebuhr; W Reinpold; K Zarras; R Bittner Journal: Chirurg Date: 2018-08 Impact factor: 0.955
Authors: Kathleen Lockhart; Douglas Dunn; Shawn Teo; Jessica Y Ng; Manvinder Dhillon; Edward Teo; Mieke L van Driel Journal: Cochrane Database Syst Rev Date: 2018-09-13