Shouldice Versus Lichtenstein Hernia Repair Techniques: A Prospective Randomized Study

Wamalwa AO1, Siwo EA2, Mohamed M3

  1. School of Medicine, University of Nairobi.

  2. Provincial General Hospital, Garissa.

  3. Mama Lucy Kibaki Hospital, Nairobi

Correspondence to: Dr. Ernest Amos Siwo, P.O Box 29-70100, Garissa, Kenya. Email:



Background: The objectives of this study was to compare the tension-free mesh (Lichtenstein), and the 4-layer tissue repair (Shouldice) techniques of inguinal hernia surgery and to determine to what extent doctors in a general surgical unit were able to reproduce the excellent results reported from specialist hernia centres.

Methods: Patients with primary unilateral inguinal hernia were over an 18 month period randomized to either the Shouldice group (experiment) or to the Lichtenstein group (control). The operating time, convalescence, hospital stay, postoperative analgesic consumption and complications, were assessed and compared.

Results: There Lichtenstein group had a shorter operating time but had a higher occurrence of persistent postoperative pain compared to the Shouldice group. There was no significant difference in convalescence between the two groups and no recurrences have been recorded in either group.

Conclusion: Despite Shouldice being more challenging to perform compared to Lichtenstein, the postoperative results are comparable. Our experience shows that both procedures can be taught to medical officers who can perform them with relative safety, efficacy and reproducibility to surgeons. Shouldice method being the more cost effective procedure should be encouraged in men with primary unilateral inguinal hernias.

Key Words: Hernia, Lichtenstein, Shouldice, Clinical Trial


The Annals of African Surgery is the official publication of the Surgical Society of Kenya.


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