Tissue-Based Inguinal Hernia Repairs Offer Advantages to Mesh Repairs

Ellis R, Maskal SM, Miller BT, et al. Shouldice vs Lichtenstein Inguinal Hernia Repair: A Propensity Score-Matched Analysis Comparing Early Postoperative Pain and Quality of Life. J Am Coll Surg. 2025; in press.

The most common approach to inguinal hernia repair (IHR) is mesh-based using the Lichtenstein technique. Given the concern over long-term mesh-related complications such as chronic pain and infection, researchers, including Ryan Ellis, from the Cleveland Clinic Center for Abdominal Health in Ohio, compared short-term pain and quality of life (QoL) between the Lichtenstein technique and the tissue-based Shouldice technique.

Using the Abdominal Core Health Quality Collaborative (ACHQC) database, the research identified 1,600 patients who underwent open IHR between January 2017 and April 2023 by either Shouldice or Lichtenstein technique. After propensity scored matching by age, body mass index, diabetes status, smoking, and other factors, 292 patients remained.

The researchers found that operative times were significantly shorter in the Shouldice group compared to the Lichtenstein group, with a majority of Shouldice cases (71%) being completed in less than 1 hour. Additionally, they found no difference in pain scores, QoL, or restrictions in activity between the two groups at 30 days; importantly, patients in the Shouldice group took fewer post-operative opioids.

The authors advised that their findings should guide shared decision-making discussions when considering which approach to perform in suitable IHR candidates.