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Evidence summaries

Shouldice Technique Versus other Open Techniques for Inguinal Hernia Repair

Shouldice technique appears to be the best non-mesh method of inguinal hernia repair in terms of recurrence. The use of mesh reduces recurrence even more. Level of evidence: "B"

A Cochrane review [Abstract] 2 included 16 studies with a total of 5411 subjects. Only 3% of the included patients were female. The length of follow-up varied broadly among the studies from 1 year to 13.7 years. The recurrence rate with Shouldice techniques was higher than mesh techniques (3.6% vs. 0.8%; OR 3.80, 95% CI 1.99 to 7.26; 6 studies, n=1565) but lower than non-mesh techniques (4.4% vs. 6.9%; OR 0.62, 95% CI 0.45 to 0.85; 8 studies, n= 2865). There were no significant differences in chronic pain, complications and post-operative stay.

Comment: The quality of evidence is downgraded by study quality (unclear allocation concealment, lack of blinding, and inadequate intention-to-treat adherence).

References

  • Amato B, Moja L, Panico S et al. Shouldice technique versus other open techniques for inguinal hernia repair. Cochrane Database Syst Rev 2012;(4):CD001543. [PubMed].

Primary/Secondary Keywords