Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures

Objective: To compare the Lichtenstein, tension-free mesh, and the Shouldice, 4-layer Bassini repair of the inguinal hernia. Design: Prospective randomized clinical trial. Setting: A private suburban hernia center. Patients: Six hundred seventy-two men with inguinal hernias, aged 20 to 90 years, seen at the hernia center between January 1, 1990, and December 31, 1995. Interventions: Slightly modified Shouldice and Lichtenstein repairs were used to repair primary and recurrent inguinal hernias. Main Outcome Measures: Recurrence rates, symptoms (including patient satisfaction), and infections. Results: A total of 717 repairs in 672 patients, including 45 bilateral repairs, have been monitored to date. Recurrence of he mia occurred in 7 Shouldice repairs and 2 mesh repairs. Twelve superficial infections associated with Shouldice and 6 associated with mesh repairs were found. Conclusions: Both types of hernia repair are comparable and effective, but long-term results favor the Lichtenstein technique for reducing recurrences (to a P value of .10), ease of technical mastery, and application to the outpatient setting by use of a local anesthetic.