The place of Shouldice operation in inguinal hernia repair

The Shouldice operation has been increasingly applied in our department since 1996. Between 1998-2000 its proportion has achieved 58% (Lichtenstein: 30%, laparoscopy: 2%, TEPP: 3%, other: 7%). A total of 343 patients have been operated on according to Shouldice. These patients were followed for 3-5 years in the mean. So far we observed 3 recurrences corresponding to a recurrence rate of 0.9%. The recurrence rate decreased compared to a historical control group from 10 to 0.9% using the Shouldice technique instead of Bassini. We conclude from this study that the surgeon must know several surgical techniques and choose the most applicable one during operation. The overwhelming majority of cases can be resolved by the Shouldice operation. For elderly patients, the Lichtenstein operation is an appropriate alternative. For cases with large defects of the posterior wall we can choose between Lichtenstein operation, the laparoscopic procedures and transinguinal preperitoneal mesh plasty.