Shouldice technique shown to be better than mesh – but still not recommended

Hernia Discussion Forums Hernia Discussion Shouldice technique shown to be better than mesh – but still not recommended

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    • #29203
      Good intentions

      I think that I’ve posted this paper before. I just looked through it again and was struck by how the authors seemed afraid to just say directly what their own analysis showed. Instead, they fell back on the old canard that more work needs to be done. I respect the fact they could not twist the data to support the use of mesh but am disappointed that they were afraid to just come out and say what the analysis showed – Shouldice should be used for select patients.

      The paper is linked from the Herniamed web site. Herniamed seems to bge a group put together by the mesh makers to promote mesh. The front page has most of the logos for the big mesh makers. It almost looks like an advertisement for device makers, which, in a way, it is.

      Notice the mesh design used as the background for the web page.

      Instead of saying “should be used” because it gives better results, they say “can be used”. And they use “comparable” instead of “better”. It is progress though. Maybe the giant ship is turning.

      The most important characteristics of the Shouldice patient collective were younger patients with a mean age of 40 years, a large proportion of women of 30%, a mean BMI value of 24 and a proportion of defect sizes up to 3 cm of over 85%. For this selected patient collective, propensity score matched-pair analysis did not identify any difference in the perioperative and one-year follow-up outcome compared with TAPP, fewer intraoperative (0.5 vs. 1.3%; p = 0.009) but somewhat more postoperative complications (2.3 vs. 1.5%; p = 0.050) compared with TEP and advantages with regard to pain at rest (4.6 vs. 6.1%; p = 0.039) and on exertion (10.0 vs. 13.4%; p < 0.001) compared with the Lichtenstein technique.

      For a selected group of patients the Shouldice technique can be used for primary unilateral inguinal hernia repair while achieving an outcome comparable to that of Lichtenstein, TEP and TAPP operations.”

    • #29204

      Wrote a lengthy response, only to have my login timed out, and the message lost.

      I do not have the motivation to re type it.

      Instead, I’ll just say thanks to @GoodIntentions for keeping the spotlight on this topic.

    • #29208

      I think the real question is whether many of the next generation of general surgeons should (or even could) be trained how to do a good primary tissue repair as part of their armamentarium?

      Even if someone is an excellent candidate for it, it’s just not an option right now it seems.

      So many generations have been brought up on mesh based repairs that you probably don’t even have the experience among the faculty to teach this if you wanted?

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