Prospective randomized comparison of the Shouldice and Lichtenstein hernia repair procedures.

OBJECTIVE To compare the Lichtenstein, tension-free mesh, and the Shouldice, 4-layer Bassini repair of the inguinal hernia. DESIGN Prospective randomized clinical trial. SETTING A private suburban hernia center. PATIENTS Six hundred seventy-two men with inguinal hernias, aged 20 to 90 years, seen at the hernia center between January 1, 1990, and December 31, 1995. INTERVENTIONS Slightly modified Shouldice and Lichtenstein repairs were used to repair primary and recurrent inguinal hernias. MAIN OUTCOME MEASURES Recurrence rates, symptoms (including patient satisfaction), and infections. RESULTS A total of 717 repairs in 672 patients, including 45 bilateral repairs, have been monitored to date. Recurrence of hernia occurred in 7 Shouldice repairs and 2 mesh repairs. Twelve superficial infections associated with Shouldice and 6 associated with mesh repairs were found. CONCLUSIONS Both types of hernia repair are comparable and effective, but long-term results favor the Lichtenstein technique for reducing recurrences (to a P value of .10), ease of technical mastery, and application to the outpatient setting by use of a local anesthetic.