title: Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia.
abstract: BACKGROUND
  The Shouldice technique is the 'gold standard' of open non-mesh hernia repair. The aim of this study was to compare 5-year recurrence rates after Shouldice and laparoscopic transabdominal preperitoneal patch (TAPP) repair for primary inguinal hernia.
  
  
  METHODS
  Men with a primary unilateral inguinal hernia were randomized to either Shouldice or TAPP operation. An independent observer scored the surgeons' performance. Follow-up comprised clinical examination after 1 year, a questionnaire after 2 and 3 years, and a clinical examination after 5 years.
  
  
  RESULTS
  Between February 1993 and March 1996, 1183 patients were included. Nine hundred and twenty patients were followed for 5 years, 454 in the TAPP group and 466 in the Shouldice group. Recurrences were evenly distributed between groups throughout the follow-up period. The cumulative recurrence rate after 5 years was 6.6 per cent in the TAPP group and 6.7 per cent in the Shouldice group. Postoperative pain was a risk factor for recurrence after Shouldice operation but not after TAPP repair. There was a correlation between a low surgeon's performance score and recurrence.
  
  
  CONCLUSIONS
  The 5-year recurrence rate is acceptable, with no difference between TAPP and Shouldice repair. Poor operative performance resulted in a higher recurrence rate. The TAPP operation represents an excellent alternative for primary inguinal hernia repair.
authors.affiliation: Department of Surgery, Karolinska Hospital, Stockholm, Sweden.
authors.forename: D
authors.initials: D
authors.lastname: Arvidsson
authors.forename: F H
authors.initials: FH
authors.lastname: Berndsen
authors.forename: L G
authors.initials: LG
authors.lastname: Larsson
authors.forename: C-E
authors.initials: CE
authors.lastname: Leijonmarck
authors.forename: G
authors.initials: G
authors.lastname: Rimbäck
authors.forename: C
authors.initials: C
authors.lastname: Rudberg
authors.forename: S
authors.initials: S
authors.lastname: Smedberg
authors.forename: L
authors.initials: L
authors.lastname: Spangen
authors.forename: A
authors.initials: A
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012307:Risk Factors; D013526:Surgical Mesh; D016896:Treatment Outcome