SHOULDICE INGUINAL-HERNIA REPAIR IN THE MALE-ADULT - THE GOLD STANDARD - A MULTICENTER CONTROLLED TRIAL IN 1578 PATIENTS

Background Hernia repair is the second most frequently performed opera tion in France and in the United States, the prevalence being 36 for e very 1000 males. Lowering the recurrence rate by 1% would mean 1000 fe wer operations for hernia repair per year in France. Methods Between 1 983 and 1989, 1578 adult males with a total of 1706 nonrecurrent ingui nal hernias were prospectively and randomly allotted to undergo either a Bassini's repair, Cooper's ligament, or Shouldice repair with polyp ropylene or a Shouldice repair with stainless steel for determination of which technique was associated with the lowest recurrence rate. Fif ty-nine hernia repairs were withdrawn after inclusion. Of the 1647 rem aining hernias, 52.2% were indirect, 25.6% were direct, and 23.2% were combined. Patients were seen every 6 months for 3 years and then ever y year. Median follow-up was 5 years 8 months (range, 3 months-8.5 yea rs). Results At 8.5 years, 5.6% of hernias were lost to follow-up. Nin ety-seven hernia repairs failed, 50% during the first 2 years. The act uarial recurrence rate was 7.94% at 8.5 years. The Shouldice repair (s tainless steel or polypropylene) was associated with fewer recurrences (6.1%) than either the Bassini's (8.6%) or Cooper's ligament repair ( 11.2%)technique (p < 0.001). This difference remained significant even when the maximal bias test was used. Fewer recurrences (5.9%) were ob served with the stainless steel wire Shouldice repair than with polypr opylene version (6.5%), but the difference was not significant. Conclu sions Shouldice hernia repair provides the patient with the best chanc es of nonrecurrence regardless of the anatomical type of hernia. The S houldice hernia repair should be the gold standard for inguinal hernia repair in men and serves as the basis for comparison with all other t echniques, be they prosthetic or laparoscopic.