Amato Bruno, Moja Lorenzo, Panico Salvatore, Persico Giovanni, Rispoli Corrado, Rocco Nicola, Moschetti Ivan
Dipartimento di Chirurgia Generale (Edif. 6), Universita degli Studi di Napoli, Via S. Pansini, 5, Napoli, Italy, 80131.
Cochrane Database Syst Rev. 2009 Oct 7(4):CD001543. doi: 10.1002/14651858.CD001543.pub3.
Inguinal hernia repair is the most frequent operation in general surgery. There are several techniques: the Shouldice technique is sometimes considered the best method but different techniques are used as the "gold standard" for open hernia repair. Outcome measures, such as recurrence rates, complications and length of post operative stay, vary considerably among the various techniques.
To evaluate the efficacy and safety of the Shouldice technique compared to other non-laparoscopic techniques for hernia repair.
We searched MEDLINE, EMBASE, and The Cochrane Central Register of Controlled Trials (CENTRAL), April 2008, for relevant randomised controlled trials.
Any randomised or quasi-randomised controlled trials (RCT) on the treatment of primary inguinal hernia in adults were considered for inclusion.
All abstracts identified by the search strategies were assessed by two independent researchers to exclude studies that did not meet the inclusion criteria. The full publications of all possibly relevant abstracts were obtained and formally assessed. Missing or updated informations was sought by contacting the authors.
Sixteen trials contributed to this review. A total of 2566 hernias were analysed in the Shouldice group with 1121 mesh and 1608 non-mesh techniques. The recurrence rate with Shouldice techniques was higher than mesh techniques (OR 3.80, 95% CI 1.99 to 7.26) but lower than non-mesh techniques (OR 0.62, 95% CI 0.45 to 0.85). There were no significant differences in chronic pain, complications and post-operative stay. Female were nearly 3% of included patients.
AUTHORS' CONCLUSIONS: Shouldice herniorrhaphy is the best non-mesh technique in terms of recurrence, though it is more time consuming and needs a slightly longer post-operative hospital stay. The use of mesh is associated with a lower rate of recurrence. The quality of included studies, assessed with jaded scale, were low. Patients have similar characteristic in the treatment and control group but seems more healthy than in general population, this features may affect the dimension of effect in particularly recurrence rate could be higher in general population. Lost to follow-up were similar in the treatment and control group but the reasons were often not reported. The length of follow-up vary broadly among the studies from 1 year to 13.7 year.
腹股沟疝修补术是普通外科最常见的手术。有多种技术：Shouldice技术有时被认为是最佳方法，但不同技术被用作开放疝修补的“金标准”。诸如复发率、并发症和术后住院时间等结果指标在各种技术之间差异很大。
评估Shouldice技术与其他非腹腔镜疝修补技术相比的疗效和安全性。
我们于2008年4月检索了MEDLINE、EMBASE和Cochrane对照试验中央注册库（CENTRAL），以查找相关的随机对照试验。
纳入任何关于成人原发性腹股沟疝治疗的随机或半随机对照试验（RCT）。
由两名独立研究人员对检索策略所识别的所有摘要进行评估，以排除不符合纳入标准的研究。获取所有可能相关摘要的全文出版物并进行正式评估。通过联系作者获取缺失或更新的信息。
16项试验纳入本综述。Shouldice组共分析了2566例疝，其中1121例采用补片技术，1608例采用非补片技术。Shouldice技术的复发率高于补片技术（比值比3.80，95%可信区间1.99至7.26），但低于非补片技术（比值比0.62，95%可信区间0.45至0.85）。慢性疼痛、并发症和术后住院时间方面无显著差异。女性占纳入患者的近3%。
就复发而言，Shouldice疝修补术是最佳的非补片技术，尽管它耗时更长，术后住院时间略长。使用补片与较低的复发率相关。用 Jadad 量表评估，纳入研究的质量较低。治疗组和对照组患者具有相似特征，但似乎比一般人群更健康，这一特征可能影响效应大小，特别是复发率在一般人群中可能更高。治疗组和对照组失访情况相似，但原因往往未报告。各研究的随访时间差异很大，从1年到13.7年不等。
