LONG-TERM FOLLOW-UP (12-15 YEARS) OF A RANDOMIZED CONTROLLED TRIAL COMPARING BASSINI-STETTEN, SHOULDICE, AND HIGH LIGATION WITH NARROWING OF THE INTERNAL RING FOR PRIMARY INGUINAL-HERNIA REPAIR

Background: Shouldice repair for primary inguinal hernia is reported t o have better results than classic Bassini-type repairs. The indirect inguinal hernia with a firm posterior nail is often assumed to be adeq uately treated by high ligation and ring narrowing, Study Design: This double randomized controlled trial compared high ligation and ring na rrowing with Bassini-Stetten repair for the indirect inguinal hernia w ith a firm posterior wall, and Shouldice with Bassini-Stetten repair f or the inguinal hernia with a weakened posterior wall, direct or indir ect. This report focuses on longterm (12-15 years) recurrence rates. R esults: From July 1980 to May 1983, 102 indirect primary inguinal hern ias with a firm posterior wall (group I) and 263 primary inguinal hern ias with a weakened posterior wall (group II) were included. By 1995, 89 patients with 100 hernia repairs had died, and for 30 repairs the p atients could not be located. In 41 hernia repairs, a recurrence had b een established previously Of the remaining 194 hernia repairs, follow up was updated by physical examination in 179 (92%) and by telephone i nterview in 15 (8%). A total of 83 recurrences were recorded, 42% of w hich were asymptomatic at the time of diagnosis. Seventy-three percent of the recurrences happened > 2 years after the operation. The Life-t able method showed the following longterm (12-15 years) recurrence rat es: group I, Bassini-Stetten 33% versus ring narrowing 34%; group II, Bassini-Stetten 32% versus Shouldice 15% (p = 0.033). Conclusions: The Shouldice is the best type of hernia repair, although the 15% recurre nce rate is high. Bassini-Stetten and high Ligation with ring narrowin g are inadequate repairs, regardless of the type of hernia, (C) 1997 b y the American College of Surgeons.