Effect of tension induced by Shouldice repair on postoperative course and long-term outcome.
OBJECTIVE
To record intraoperative tension during Shouldice hernioplasty and correlate it with postoperative course and long-term outcome.


METHODS
Prospective clinical trial.


METHODS
University clinic, Germany.


METHODS
20 male patients undergoing elective primary inguinal hernia repair by Shouldice technique.


METHODS
Measurement of intraoperative tension during hernioplasty (low 0-2.0 N, moderate 2.1-4.0 N, high > 4.1 N).


METHODS
Postoperative pain measured by visual analogue scale (VAS) at rest and activity, pain-related change of ventilatory measurements (8, 24 and 48 hours after intervention), postoperative complications, length of stay in hospital, and recurrence rate at mean 46.7 (range 43-54) months after operation. Data are given as mean (SD).


RESULTS
The results for 18 patients were analysed, 2 being lost to follow up. Mean pain score was 17.5 (15.6), 14.8 (15.6) and 12.3 (14.9) at rest 8 hours, 24 hours and 48 hours after operation, during activity 42.0 (16.5), 36.4 (18.5) and 33.7 (19.1) respectively. Most depression of ventilatory measurements was found 8 hours after operation (vital capacity 88.4 (12.5)%. peak flow 81.3 (17.2)%) compared with preoperative values. Complications comprised one seroma, one subcutaneous wound infection, and 3 haematomas. Mean length of stay in hospital was 4.3 (range 2-7) days. At follow up, no recurrences were found. No correlation with intraoperatively-induced tension was found.


CONCLUSIONS
Postoperative pain and recurrences depend on many factors, but induced intraoperative tension can be excluded. The reported advantages of tension-free procedures are not based on the avoidance of tension. The Shouldice repair can therefore continued to be used as a routine technique in uncomplicated primary inguinal hernia repair.
Junge
Karsten
K
Department of Surgery, Technical University of Aachen, Germany. mail@kjunge.de
Peiper
Christian
C
Rosch
Raphael
R
Lynen
Petra
P
Schumpelick
Volker
V
D000328:Adult; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010149:Postoperative Pain / Q000453:epidemiology; D011446:Prospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome; D014797:Vital Capacity