Randomized clinical trial comparing totally extraperitoneal inguinal hernia repair with the Shouldice technique

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Abstract
Background: The optimal technique for inguinal hernia repair remains contentious. This study compared the Shouldice repair with the totally extraperitoneal endoscopic (TEP) method in a randomized clinical trial, with quality of life (QoL) and cost analysis. Methods: Two hundred patients were randomized to Shouldice or TEP repair. Patients were assessed after operation by questionnaire to determine operative outcomes, complications, QoL, and return to work and normal lifestyle. Results: There were 117 TEP and 115 Shouldice repairs. Median operating time was longer for TEP repair (70 versus 56 min; P = 0·0001), but patients were discharged earlier (68 versus 48 per cent within 1 day; P = 0·0065), and had a quicker return to work (14 versus 30 days; P = 0·0001) and normal lifestyle (21 versus 35 days; P = 0·0001). Open repair was nearly 40 per cent cheaper. Late follow-up in 171 patients (86 per cent) at a median of 1·3 years found that TEP repair led to fewer complications at 1 year (9 versus 21 per cent; P = 0·05) and was associated with significant improvement for the QoL components of work performance and satisfaction, physical symptoms and sense of well-being. Conclusion: TEP repair results in fewer complications and an earlier return to work and normal lifestyle, but is more expensive and takes longer to perform.