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Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group

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Abstract

Background

In recent years long-term discomfort after inguinal hernia surgery has become an issue of great concern to hernia surgeons. Long-term results on discomfort from large randomised studies are sparse.

Methods

One-thousand one-hundred and eighty-three patients were randomised in a multicentre trial with the primary aim of comparing recurrence rates after laparoscopic TAPP and Shouldice repair. Evaluating late discomfort and its possible risk factors were secondary objectives, and are reported here. The patients were clinically examined after 1 and 5 years, and answered questionnaires 2 and 3 years postoperation.

Results

Of 1,068 operated patients, 867 were eligible for analysis after 5 years (81.2%). The percentage of patients experiencing discomfort of any kind were 8.5% in the TAPP group and 11.4% (p = 0.156) in the Shouldice group. Although discomfort was usually mild it was severe for 0.2 and 0.7%, respectively. Severe pain the first postoperative week was a risk factor for late discomfort in the Shouldice group (OR 2.25, P = 0.022) but not in the TAPP group. No other risk factor for late discomfort was found.

Conclusion

There was no difference between late discomfort at five-year follow-up after laparoscopic TAPP and Shouldice repair. Discomfort was mostly mild and pain during the first postoperative week was a prognostic variable for late discomfort in Shouldice patients.

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References

  1. Welsh DRJ, Alexander MAJ (1993) The shouldice repair. Surg Clin North Am 73:451–469

    PubMed  CAS  Google Scholar 

  2. Devlin HB, Gillen PHA, Waxman BP, MacNay RA (1986) Short stay surgery for inguinal hernia: experience of the shouldice operation, 1970–1982. Br J Surg 73:123–124

    Article  PubMed  CAS  Google Scholar 

  3. McGillicuddy JE (1998) Prospective randomized comparison of the shouldice and Lichtenstein hernia repair procedures. Arch Surg 133:974–978

    Article  PubMed  CAS  Google Scholar 

  4. Danielsson P, Isacson S, Hansen MV (1999) Randomized study of Lichtenstein compared with shouldice inguinal hernia repair by surgeons in training. Eur J Surg 165:49–53

    PubMed  CAS  Google Scholar 

  5. Tran VK, Pütz T, Rohde H (1992) A randomized controlled trial for inguinal hernia repair to compare the Shouldice and the Bassini–Kirschner operation. Int Surg 77:235–237

    PubMed  CAS  Google Scholar 

  6. Beets GL, Oosterhuis KJ, Go PMNYH, Baeten CG, Kootstra G (1997) Longterm follow up (12–15 years) of a randomized controlled trial comparing Bassini–Stetten, Shouldice, and high ligation with narrowing of the internal ring for primary inguinal hernia repair. J Am Coll Surg 185:365–370

    Google Scholar 

  7. Nordin P, Bartelmess P, Jansson C, Svensson C, Edlund G (2002) Randomized trial of Lichtenstein versus Shouldice hernia repair in general surgical practice. Br J Surg 89:45–49

    Article  PubMed  CAS  Google Scholar 

  8. Lichtenstein IL (1987) Herniorrhaphy—a personal experience with 6,321 cases. Am J Surg 153:553–559

    Article  PubMed  CAS  Google Scholar 

  9. Amid PK, Shulman AG, Lichtenstein IL (1994) A critical evaluation of the Lichtenstein tension-free hernioplasty. Int Surg 79:76–79

    PubMed  CAS  Google Scholar 

  10. Rutkow IM, Robbins AW (1993) “Tension-free” inguinal herniorrhaphy: a preliminary report on the “mesh plug” technique. Surgery 114:3–8

    PubMed  CAS  Google Scholar 

  11. Kugel RD (2003) Minimally invasive, nonlaparoscopic, preperitoneal, and sutureless, inguinal herniorrhaphy. Am J Surg 178:298–302

    Article  Google Scholar 

  12. Arregui ME, Navarrete J, Davis CJ, Castro D, Nagan RF (1993) Laparoscopic inguinal herniorrhaphy: techniques and controversies. Surg Clin North Am 73:513–527

    PubMed  CAS  Google Scholar 

  13. Juul P, Christensen K (1999) Randomized clinical trial of laparoscopic versus open inguinal hernia repair. Br J Surg 86:316–319

    Article  PubMed  CAS  Google Scholar 

  14. Lawrence K, McWhinnie D, Goodwin A, Doll H, Gordon A, Gray A, Britton J, Collin J (1995) Randomised controlled trial of laparoscopic versus open repair of inguinal hernia: early results. BMJ 311:981–985

    PubMed  CAS  Google Scholar 

  15. Wellwood J, Sculpher MJ, Stoker D, Nicholls GJ, Geddes C, Whitehead A, Singh R, Spiegelhalter D (1998) Randomized controlled trial of laparoscopic versus open mesh repair for inguinal hernia: outcome and cost. BMJ 317:103–110

    PubMed  CAS  Google Scholar 

  16. Liem MSL, Van Der Graaf Y, Van Steensel CJ, Boelhouwer RU, Clevers GJ, Meijer WS, Stassen LP, Vente JP, Weidema WF, Schrijvers AJ, van Vroonhoven TJ (1997) Comparison of conventional anterior surgery and laparoscopic surgery for inguinal hernia repair. N Engl J Med 336:1541–1547

    Article  PubMed  CAS  Google Scholar 

  17. Bay-Nielsen M, Nilsson E, Nordin P, Kehlet H (2004) Chronic pain after open mesh and sutured repair of indirect hernia in young males. Br J Surg 91:1372–1376

    Article  PubMed  CAS  Google Scholar 

  18. Callesen T, Bech K, Kehlet H (1999) Prospective study of chronic pain after groin hernia repair. Br J Surg 86:1528–1531

    Article  PubMed  CAS  Google Scholar 

  19. Cunningham J, Temple WJ, Mitchell P, Nixon JA, Preshaw RM, Hagen NA (1996) Cooperative hernia study: pain in the postrepair patient. Ann Surg 224:598–602

    Article  PubMed  CAS  Google Scholar 

  20. McCormack K, Scott NW, Go PM, Ross S, Grant AM and the EU Hernia Trialists Collaboration (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev (1)CD001785

  21. Bittner R, Sauerland S, Schmedt C-G (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surg Endosc 19:605–615

    Article  PubMed  CAS  Google Scholar 

  22. Schmedt C-G, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open-mesh techniques for inguinal hernia repair. A meta-analysis of randomized controlled trials. Surg Endosc 19:188–199

    Article  PubMed  CAS  Google Scholar 

  23. Douek M, Smith G, Oshowo A, Stoker DL, Wellwood JM (2003) Prospective randomised controlled trial of laparoscopic versus open inguinal hernia mesh repair: five year follow-up. BMJ 326:1012–1013

    Article  PubMed  CAS  Google Scholar 

  24. Grant AM, Scott NW, O’Dwyer PJ, on behalf of the MRC Laparoscopic Groin Hernia Trial Group (2004) Five-year follow-up of a randomized trial to assess pain and numbness after laparoscopic or open repair of groin hernia. Br J Surg 91:1570–1574

    Google Scholar 

  25. Liem MSL, van Duyn EB, van der Graaf Y, van Vroonhoven TJMV, on behalf of the Coala Trial Group (2003) Recurrences after conventional anterior and laparoscopic inguinal hernia repair. A randomized comparison. Ann Surg 237:136–141

    Google Scholar 

  26. Nienhuijs SW, van Oort I, Keemers-Gels ME, Strobbe LJA, Rosman C (2005) Randomized clinical trial comparing the Prolene® hernia system, mesh plug repair and Lichtenstein method for open inguinal hernia repair. Br J Surg 92:33–38

    Article  PubMed  CAS  Google Scholar 

  27. Berndsen F, Arvidsson D, Enander L-K, Leijonmarck CE, Wingren U, Rudberg C, Smedberg S, Wickbom G, Montgomery A (2002) Postoperative convalescence after inguinal hernia surgery: prospective randomised multicenter study of laparoscopic versus Shouldice inguinal hernia repair in 1042 patients. Hernia 6:56–61

    Article  PubMed  CAS  Google Scholar 

  28. Arvidsson D, Berndsen FH, Larsson LG, Leijonmarck CE, Rimback G, Rudberg C, Smedberg S, Spangen L, Montgomery A (2005) Randomized clinical trial comparing 5-year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. Br J Surg 92:1085–1091

    Article  PubMed  CAS  Google Scholar 

  29. Nyhus LM (1993) Individualization of hernia repair: a new era. Surgery 114:1–2

    PubMed  CAS  Google Scholar 

  30. Swedish hernia register 2004. http://www.svensktbrackregister.se/pdf/red04.pdf

  31. Kehlet H, Bay-Nielsen M, Kingsnorth A (2002) Chronic postherniorrhaphy pain—a call for uniform assessment. Hernia 6:178–181

    Article  PubMed  CAS  Google Scholar 

  32. Haapaniemi S, Nilsson E. Recurrence, pain three years after groin hernia repair (2002) Validation of postal questionnaire and selected physical examination as a method of follow-up. Eur J Surg 168:22–28

    Google Scholar 

  33. Klinge U, Junge K, Stumpf M, Öttinger AP, Klosterhalfen B (2002) Functional and morphological evaluation of a low-weight, monofilament polypropylene mesh for hernia repair. J Biomed Mater Res 63:129–136

    Article  PubMed  CAS  Google Scholar 

  34. Klosterhalfen B, Klinge U, Schumpelick V (1998) Functional and morphological evaluation of different polypropylene-mesh modifications for abdominal wall repair. Biomaterials 19:2235–2246

    Article  PubMed  CAS  Google Scholar 

  35. O’Dwyer PJ, Kingsnorth AN, Molloy RG, Small PK, Lammers B, Horeyseck G (2005) Randomized clinical trial assessing impact of a lightweight or heavyweight mesh on chronic pain after inguinal hernia repair. Br J Surg 92:166–170

    Article  PubMed  CAS  Google Scholar 

  36. Bringman S, Wollert S, Österberg J, Smedberg S, Granlund H, Fellander G, Heikkinen T (2005) One year results of a randomised controlled multi-centre study comparing Prolene and Vypro II- mesh in Lichtenstein herniaplasty. Hernia 9:223–227

    Article  PubMed  CAS  Google Scholar 

  37. Topart P, Vanden broucke P, Lozac’h P (2005) Tisseel vs tack staples as mesh fixation in totally extraperitoneal laparoscopic repair of groin hernias. Surg Endosc 19:724–727

    Article  PubMed  CAS  Google Scholar 

  38. Schwab R, Willms A, Kroger A, Becker HP (2006) Less chronic pain following mesh fixation using a fibrin sealant in TEP inguinal hernia repair. Hernia 10:272–277

    Article  PubMed  CAS  Google Scholar 

  39. Lau H (2005) Fibrin sealant versus mechanical stapling for mesh fixation during endoscopic extraperitoneal inguinal hernioplasty. A randomised prospective trial. Ann Surg 242:670–675

    Article  PubMed  Google Scholar 

  40. Moreno-Egea A, Martinez JAT, Cuenca GM, Albasini JLA (2004) Randomized clinical trial of fixation vs nonfixation of mesh in total extraperitoneal inguinal hernioplasty. Arch Surg 139:1376–1379

    Article  PubMed  Google Scholar 

  41. Fitzgibbons RJ, Giobbie-Hurder A et al (2006) Watchful waiting vs repair of inguinal hernia in minimally symptomatic men. A randomized clinical trial. JAMA 295:285–292

    Article  PubMed  CAS  Google Scholar 

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Acknowledgments

Other surgeons participating in this trial: Per Almqvist, Universitetssjukhuset MAS, Malmö, Magnus Bergenfeldt, Universitetssjukhuset MAS, Malmö, Ib Rasmussen, Akademiska sjukhuset, Uppsala, Eva Lundgren, Akademiska sjukhuset, Uppsala, Jan Antonsson, Akademiska sjukhuset, Uppsala, Ingrid Svedberg, S:t Görans sjukhus, Stockholm, Jon Ahlberg, S:t Görans Sjukshus, Stockholm, Lena Blomgren, S:t Görans sjukhus, Stockholm, Anders Hellberg, Centrallasarettet Västerås, Bo Sjögren, Centrallasarettet Västerås, Gunnar Wickbom, Regionsjukhuset Örebro, Lars-Erik Larsson, Regionsjukhuset Örebro, Erik Jörtsö, Regionsjukhuset Örebro, Göran Ågren, Regionsjukhuset Örebro, Gunnar Rimbäck, Mölndal lasarett, U. Wingren, Mölndal lasarett, LarsGöran Ekman, Mölndal lasarett, Olle Thorén, Mölndal lasarett, Leif Spangen, Karlstad lasarett, L-K Enander, Karlstad lasarett. Financial support: Ethicon EndoSurgery, Johnson and Johnson Company.

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Authors and Affiliations

  1. Department of Surgery, Akranes Hospital, 300, Akranes, Iceland

    Fritz H. Berndsen

  2. Department of Surgery, Malmö University Hospital, Malmö, Sweden

    U. Petersson & A. Montgomery

  3. Department of Surgery, St Göran’s Hospital, Stockholm, Sweden

    D. Arvidsson & C.-E. Leijonmarck

  4. Department of Surgery, Västerås Hospital, Västerås, Sweden

    C. Rudberg

  5. Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden

    S. Smedberg

Authors
  1. Fritz H. Berndsen
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  2. U. Petersson
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  3. D. Arvidsson
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  4. C.-E. Leijonmarck
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  5. C. Rudberg
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  6. S. Smedberg
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  7. A. Montgomery
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Corresponding author

Correspondence to Fritz H. Berndsen.

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Berndsen, F.H., Petersson, U., Arvidsson, D. et al. Discomfort five years after laparoscopic and Shouldice inguinal hernia repair: a randomised trial with 867 patients. A report from the SMIL study group. Hernia 11, 307–313 (2007). https://doi.org/10.1007/s10029-007-0214-7

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