Randomised study of Lichtenstein compared with Shouldice inguinal hernia repair by surgeons in training

Objective: To compare the outcome following Lichtenstein open mesh technique or Shouldice repair for inguinal hernia operated on by surgeons in training. Design: Prospective, randomised, trial. Setting: District hospital, Sweden. Subjects: 200 men with primary inguinal hernias. Interventions: Lichtenstein mesh repair or Shouldice repair. Main outcome measures: Duration of operation, postoperative pain assessed by visual analogue scale (VAS), complications within 30 days, duration of sick leave, and recurrence within one year. Results. 178 patients were available for evaluation (n = 89 in each group). There were no significant differences in duration of operation, pain score, or incidence of postoperative complications. Patients in the mesh group took significantly less sick leave (mean 18.2 days) than those in the Shouldice group (23.8 days, p < 0.05). The number of recurrences differed significantly between the groups with 9 in the Shouldice group and none in the mesh group (p < 0.01). Conclusion: For surgeons in training the Lichtenstein open mesh technique is a better method of inguinal hernia repair than the Shouldice technique. The outcome is better for the patients and it is more cost-effective.