title: Effect of tension induced by Shouldice repair on postoperative course and long-term outcome.
abstract: 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.
authors.affiliation: Department of Surgery, Technical University of Aachen, Germany. mail@kjunge.de
authors.forename: Karsten
authors.initials: K
authors.lastname: Junge
authors.forename: Christian
authors.initials: C
authors.lastname: Peiper
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosch
authors.forename: Petra
authors.initials: P
authors.lastname: Lynen
authors.forename: Volker
authors.initials: V
authors.lastname: Schumpelick
mesh_terms: 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