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Comparison between the shouldice and falci-lichtenstein techniques on the treatment of inguinal hernias in men

OBJECTIVE: We compared the Shouldice (S) technique, a repair in four layers of continuous suture and the Falci-Lichtenstein (FL) technique that uses polypropylene prothesis. METHOD: One hundred and eighteen male patients underwent surgery, on a total of 124 hernias. Fifty-eight of them underwent inguinal hernia surgery by the FL technique, and the other 60 patients by the S technique. In each group 62 inguinais hernias with 85% of the patients were followed for four years. The average age was 52 years old. Fifty-three type 3 A hernias, 57 type 3B and 10 type 4 hernias were operated, according to the Nyhus classification. Concerning the side, there was a predominance on the right with 65 ruptures (52.4%). The anesthesia was spinal in (89.8%) of the patients. RESULTS: The bruise and the seroma were the most common postoperative complications, occuring more frequently with the FL technique. In this one there was a recurrence (0,8%), because the bandage and the inguinal ligament broke up. In another patient, a femoral rupture turned up. The patients operated through the S technique complained more about pain on the immediate postoperative period and returned to work later. The observation time wasn't the ideal, because the largest index of recurrence can be in the non controlled patients, as it's known that 40% of the recurrence occur 5 years after the primary operation and 20% 25 years after. CONCLUSIONS: Both repairs presented low rates of recurrence. The Shouldice technique is more complex, as it allows a safe exploration of the femoral channel, requires a more solid anatomical knowledge of the region and a better experience with the surgery of the inguinal hernia and it's a low cost procedure. The Falci-Lichtenstein repair is effective,rapid, causes fewer pain, fast recovery and allows less experienced inguinal hernia surgeons to accomplish it successfully.

Hernia; inguinal; Inguinal canal; Surgical procedures, operative


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