From

The object of this study was to establish the relation of symptomatic diverticula to the age and gender of the patients and to the presence of ectopic tissue. A total of 136 patients with surgically treated diverticula were collected from the medical charts of five Amsterdam hospitals; 51 had undergone resection because of diverticulum-related symptoms and 85 during laparotomy for other causes. Obstruction was the predominant symptom (39%) in the 51 symptomatic patients. Hemorrhage, perforation, diverticulitis, and intussusception were the other symptoms (12-14% each). Obstruction occurred mainly in patients under age 10 years and perforation in patients 10 to 30 years old. All symptoms, hemorrhage excepted, occurred two to four times more in men. Hemorrhage and perforation were associated with the presence of ectopic gastric tissue. We concluded that symptoms caused by Meckel's diverticula are mainly due to the presence of bands or ectopic gastric tissue. The symptoms manifest at an early age (77% in those under age 30) and predominantly in males. Diverticula found incidentally in patients younger than 30 years should be resected. In the older patients, resection is indicated if ectopic gastric tissue is suspected. Diverticular bands can simply be cut.

The Shouldice technique for inguinal hernia repair has been suggested by some authors as the best conventional method against which other methods using prostheses should be compared. The paper which follows is a systematic review involving a comprehensive search of the medical literature to identify all clinical trials (article or abstract) evaluating the Shouldice repair. After assessment of certain quality criteria, the best studies were pooled in a meta-analysis. Nine publications were found with 11 study arms. In ten studies the results of the Shouldice technique were better than the results of the control arm. Six studies could be pooled in a meta-analysis of 2500 patients; Shouldice was significantly better than control methods (relative risk 0.62 (95 per cent confidence interval 0.45-0.85)). In spite of possible bias caused by different variables (modifications in operative technique, suture material, level of surgeon, follow-up methods and outcome measurement), the results of this systematic review suggest that the Shouldice method is the best current conventional technique for inguinal hernia repair.

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