ROLE OF THE SHOULDICE TECHNIQUE IN INGUINAL-HERNIA REPAIR - A SYSTEMATIC REVIEW OF CONTROLLED TRIALS AND A METAANALYSIS

The Shouldice technique for inguinal hernia repair has been suggested by some authors as the best conventional method against which other me thods lasing prostheses should be compared, The paper which follows Is a systematic review involving a comprehensive search of the medical l iterature to identify all clinical trials (article or abstract) evalua ting he Shouldice repair, After assessment of certain quality criteria , the best studies were pooled in a meta-analysis, Nine publications w ere found with 11 study arms. In ten studies the results of the Should ice technique were better than the results of the control arm, Six stu dies could be pooled in a meta-analysis of 2500 patients; Shouldice wa s significantly better than control methods (relative risk 0.62 (95 pe r cent confidence interval 0.45-0.85)). In spite of possible bias caus ed by different variables (modifications in operative technique, sutur e material, level of surgeon, follow-up methods and outcome measuremen t), the results of this systematic review suggest that the Shouldice m ethod is the best current conventional technique for inguinal hernia r epair.