Randomized trial of modified Bassini versus Shouldice inguinal hernia repair

Abstract

Between 1986 and 1992, 265 men of mean age 51 (range 16-75) years with a primary inguinal hernia were randomized to undergo surgery by staff surgeon or surgical resident and further randomized to receive a modified Bassini operation (transversalis fascia not divided but included in the repair) or Shouldice procedure. The follow-up rate was 92.1 per cent with a mean follow-up of 3.3 years. Recurrence developed in 12 of 125 patients with a Bassini procedure and two of 119 after a Shouldice repair (9.6 versus 1.7 per cent, P = 0.006). The recurrence rate was no different for staff surgeons and trainees (5.9 versus 5.6 per cent, P not significant). Multivariate analysis identified the presence of a direct hernia (P = 0.003) as the additional main factor for the development of recurrence.

Recurrence of inguinal hernias repaired in a large hernia surgical specialty hospital and general hospitals in Ontario, Canada

“…[15][16][17][18][19][20][21][22][23][24] The reasons why the Shouldice Hospital performed so much better in our study than in the clinical trials is not clear. In addition to performing a specific type of hernia repair in a very reproducible fashion at the Shouldice Hospital, 25,26 a variety of processes of care are followed: patients are kept in hospital for several days after hernia repair, strict selection criteria are applied, and the surgeons perform extraordinarily large numbers of hernia surgeries.…”

A Comparative Study of Inguinal Hernia Repair by houldice Method Vs Other Methods

“…In the present study, we encountered two cases of recurrences (2.5%) as per Table -4. As the follow up was too short, recurrence was not as compared to standard series of A. Paul, et al [10]. …”

Tratamento das hérnias inguinais: Bassani ainda atual? Estudo randomizado, prospectivo e comparativo entre três técnicas operatórias: Bassini, Shouldice, McVay

“…Barbier 34 relata que no primeiro ano de herniorrafia por esta técnica, de um total de 1.040 pacientes operados entre 1970 e 1978, chegou a ter 47,37% de recidi- 37,38 , o método foi sendo paulatinamente adotado no mundo inteiro. Passou a ser reconhecido pela maioria dos "cirurgiões convencionais" como o método padrão-ouro para o tratamento das hérnias inguinais [39][40][41] . Glassow 42 e Bendavid 43 têm sido através de suas publicações os maiores difusores desta técnica, embora este último venha manifestando sua simpatia crescente por técnicas "sem tensão" com prótese 44 .…”