A Martín Duce1,2, O Lozano3, M Galván3, A Muriel4,5, S Villeta4, J Gómez4. 1. Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain. martinduce@gmail.com. 2. Department of General Surgery, Príncipe de Asturias University Hospital, Madrid, Spain. martinduce@gmail.com. 3. Department of General Surgery, Los Arcos del Mar Menor University Hospital, San Javier, Spain. 4. Faculty of Medicine and Health Sciences, Alcalá University, Plaza de San Diego s/n, 28801, Alcalá de Henares, Madrid, Spain. 5. Biostatistics Department, Instituto Ramón y Cajal de Investigación Sanitaria IRYCIS, CIBERESP, Ramón y Cajal University Hospital, Madrid, Spain.
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.
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.
Authors: F Köckerling; W Brunner; R Fortelny; F Mayer; D Adolf; H Niebuhr; R Lorenz; W Reinpold; K Zarras; D Weyhe Journal: Hernia Date: 2020-11-25 Impact factor: 4.739
Authors: Jessica H Beard; Michael Ohene-Yeboah; Stephen Tabiri; Joachim K A Amoako; Francis A Abantanga; Carrie A Sims; Pär Nordin; Andreas Wladis; Hobart W Harris; Jenny Löfgren Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766
Authors: M P Simons; T Aufenacker; M Bay-Nielsen; J L Bouillot; G Campanelli; J Conze; D de Lange; R Fortelny; T Heikkinen; A Kingsnorth; J Kukleta; S Morales-Conde; P Nordin; V Schumpelick; S Smedberg; M Smietanski; G Weber; M Miserez Journal: Hernia Date: 2009-07-28 Impact factor: 4.739
Authors: Ferdinand Köckerling; Andreas Koch; Ralph Lorenz; Christine Schug-Pass; Bernd Stechemesser; Wolfgang Reinpold Journal: Front Surg Date: 2015-06-16
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