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Randomized clinical trial comparing 5‐year recurrence rate after laparoscopic versus Shouldice repair of primary inguinal hernia. BJS 2005; 92: 1085-1091.

Published: 17th August 2005

Authors: D. Arvidsson, F. H. Berndsen, L. G. Larsson, C.‐E. Leijonmarck, G. Rimbäck, C. Rudberg et al.


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.


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.


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. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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