Doctors undergoing inguinal hernia repair with the three-layer Shouldice technique: The PRO*Shouldice retrospective cohort study

Abstract

PURPOSE: The Shouldice method has shown promising outcomes in reconstruction of the inguinal canal without mesh. However, measuring actual recurrence rates is difficult in clinical practice. Some studies have been applying algorithms based on Patient-Reported Outcomes (PRO) to facilitate the detection of recurrence. The aims of this study were to assess the medium- to long-term recurrence rate of the three-layer Shouldice technique in a population composed solely of doctors, validate the PRO questionnaire compared to clinical examination and ultrasound, and measure the patients’ degree of satisfaction.

MATERIALS AND METHODS: This retrospective cohort study investigates the medium- to long-term outcomes of the three-layer Shouldice technique, with a minimum follow-up of 12 months postoperatively. Patients were evaluated by comparing clinical examination results, PRO questionnaire, and ultrasound.

RESULTS: Sixty-one patients comprising 76 hernias underwent primary inguinal hernia repair with a minimum follow-up of 12 months. Results indicate a low recurrence rate of 1.3%, with one patient requiring reoperation after 18.5 years. Self-perception of recurrence through the PRO questionnaire correlated well with clinical examination findings. Ultrasonographic evaluation detected incidental findings in three cases, highlighting the selective role of imaging in postoperative care. Patient satisfaction, assessed by the Net Promoter Score (NPS), was notably high, at 96, underscoring the procedure’s acceptability among this cohort.

CONCLUSION: Overall, the three-layer Shouldice technique demonstrates comparable efficacy to that of standard methods, with minimal complications and high patient satisfaction, suggesting its viability as a suitable alternative in inguinal hernia repair.

Keywords

Herniorrhaphy / inguinal hernia / patient-reported outcomes / recurrence rate / Shouldice repair

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2025 International Journal of Abdominal Wall and Hernia Surgery | Published by Wolters Kluwer - Medknow on behalf of Higher Education Press