Kux M, Fuchsjäger N, Schemper M
Department of Surgery, St. Joseph Hospital, Vienna, Austria.
Am J Surg. 1994 Jul;168(1):15-8. doi: 10.1016/s0002-9610(05)80063-7.
The original Bassini and Shouldice methods for inguinal herniorrhaphy were tested against each other and against their respective variants that avoid permanent suturing of the internal oblique muscle. Seven hundred fifty inguinal hernia repairs were prospectively allocated to 1 of 4 groups: group A: Bassini with absorbable sutures (polyglycolic acid); group B: Bassini with nonabsorbable sutures (polyester); group C: Shouldice with four rows of polypropylene sutures; and group D: Shouldice with two rows of polypropylene sutures. Outcome was correlated to prospectively defined types and risk factors such as direct hernia, repair for recurrent hernia, hernial sac diameter greater than 8 cm, age greater than 70 years, overweight, and chronic bronchitis. Actual (not actuarial) recurrence rates were determined through clinical examination by hospital staff surgeons (not through information by letter or phone) for 93.6% of surviving patients. Local complications exclusive of recurrence, but including the redoubtable and litigious sequelae of testicular atrophy and chronic ilioinguinal pain, were significantly reduced from 6.3% (group B and C) to 2.3% by omitting permanent muscle sutures (groups A and D; P < 0.05). However, the use of slowly absorbable suture material resulted in a disproportionately high recurrence rate of 12.8% in the modified Bassini group A. The original Bassini method, ie, division of the transversalis fascia and repair with nonabsorbable sutures, as was used in group B, had an actual 2-year recurrence rate of 8.7%, still a highly significant difference compared with 3.6% and 2.3% for Shouldice groups C and D, respectively (P = 0.012). For repair of recurrent hernia, the superiority of the Shouldice technique was not statistically significant: re-recurrence rate 7.6% versus 13.5% for the original Bassini group B. Repair of recurrent hernia was the only patient-related risk factor of equal significance as the method of repair. The Shouldice technique is superior to and more than merely a reinvention of Bassini's original method. The omission of muscle sutures is physiologically sound and recommended for the Shouldice operation.
对腹股沟疝修补术的原始 Bassini 法和 Shouldice 法以及各自避免永久缝合腹内斜肌的变体方法进行了相互比较。750 例腹股沟疝修补术被前瞻性地分配到 4 组中的 1 组：A 组：使用可吸收缝线（聚乙醇酸）的 Bassini 法；B 组：使用不可吸收缝线（聚酯）的 Bassini 法；C 组：使用四排聚丙烯缝线的 Shouldice 法；D 组：使用两排聚丙烯缝线的 Shouldice 法。结果与前瞻性定义的类型和风险因素相关，如直疝、复发性疝修补、疝囊直径大于 8 cm、年龄大于 70 岁、超重和慢性支气管炎。93.6% 的存活患者由医院外科医生通过临床检查（而非通过信件或电话信息）确定实际（而非精算）复发率。排除复发但包括令人担忧且易引发诉讼的睾丸萎缩和慢性髂腹股沟疼痛后遗症的局部并发症，通过省略永久肌肉缝合（A 组和 D 组）从 6.3%（B 组和 C 组）显著降低至 2.3%（P < 0.05）。然而，在改良的 Bassini A 组中，使用缓慢吸收的缝合材料导致复发率高得不成比例，为 12.8%。B 组使用的原始 Bassini 法，即横筋膜切开并用不可吸收缝线修补，实际 2 年复发率为 8.7%，与 Shouldice C 组和 D 组的 3.6% 和 2.3% 相比仍有高度显著差异（P = 0.012）。对于复发性疝修补，Shouldice 技术的优势在统计学上不显著：B 组原始 Bassini 法的再复发率为 7.6%，而 Shouldice 技术为 13.5%。复发性疝修补是与患者相关的唯一与修补方法具有同等重要性的风险因素。Shouldice 技术优于 Bassini 原始方法，且不仅仅是对其的重新发明。省略肌肉缝合在生理上是合理的，推荐用于 Shouldice 手术。
