Kingsnorth A N, Gray M R, Nott D M
University of Liverpool, Department of Surgery, Royal Liverpool University Hospital, UK.
Br J Surg. 1992 Oct;79(10):1068-70. doi: 10.1002/bjs.1800791026.
The lowest recurrence rates after inguinal hernia repair have been achieved by specialized hernia clinics. The Shouldice repair achieves success through application of a meticulous standardized operation carried out by specialist hernia surgeons. In a trial designed to rule out surgeon-dependent variables, 322 inguinal hernias were randomized prospectively to Shouldice repair or plication darn. Fifteen general surgeons operated on 322 patients. Fourteen surgeons in training not familiar with Shouldice repair received constant supervision for six repairs before independent operation. The mean (s.d.) patient age was 58.3(1.5) (range 20-84) years for Shouldice repair and 57.0(1.2) (range 18-85 years) for plication darn. The sex ratio (M:F) was 17:1 and right side to left side ratio 1.8:1. Six-week complication rates for wound infection (Shouldice repair, 5 per cent; plication darn, 4 per cent) and haematoma (Shouldice repair, 7 per cent; plication darn, 5 per cent) were similar in both groups. There were a similar number of sliding hernias in the Shouldice repair (14) and plication darn (20) groups. After a mean follow-up of 30 (range 24-48) months there were seven recurrences in the Shouldice group and four in the plication darn group (P > 0.05). The recurrences suggest that additional supervision of junior surgeons is required during the Shouldice repair learning period.
专业疝气诊所实现了腹股沟疝修补术后最低的复发率。肖尔代斯修补术通过由专业疝气外科医生实施的细致标准化手术取得成功。在一项旨在排除外科医生相关变量的试验中，322例腹股沟疝被前瞻性随机分为肖尔代斯修补术组或褶叠缝合法组。15名普通外科医生为322例患者进行手术。14名不熟悉肖尔代斯修补术的实习外科医生在独立手术前，在持续监督下进行了6例修补手术。肖尔代斯修补术组患者的平均（标准差）年龄为58.3（1.5）岁（范围20 - 84岁），褶叠缝合法组为57.0（1.2）岁（范围18 - 85岁）。男女比例为17:1，右侧与左侧比例为1.8:1。两组伤口感染（肖尔代斯修补术组为5%；褶叠缝合法组为4%）和血肿（肖尔代斯修补术组为7%；褶叠缝合法组为5%）的六周并发症发生率相似。肖尔代斯修补术组（14例）和褶叠缝合法组（20例）滑动疝的数量相似。平均随访30（范围24 - 48）个月后，肖尔代斯组有7例复发，褶叠缝合法组有4例复发（P>0.05）。这些复发表明在肖尔代斯修补术学习期间，需要对初级外科医生进行额外监督。
