Comparação entre as técnicas de shouldice modificada por berliner e de falci-lichtenstein na hernioplastia inguinal

Abstract

Surgical repair of inguinal hernias is a common procedure in adult men. The most commonly perfomed repairs today are the Falci-Lichtenstein and the Shouldice. The first one uses a prosthetic mesh and the second one divides the transversalis fascia and creates a four layer repair. Berliner modified it to a double layer repair. There is no diffusion in the literature of this modification. The techniques were compared with regard of operative time, length of hospital stay, return to work, complications and recurrence. It was prospectively studied 312 men, over 18 years with type 3 A, 3 B e 4 of Nyhus classification inguinal hernias operated on by one single surgeon. Group 1 was composed for 84 patients treated with the Falci-Lichtenstein technique. Group 2 included 228 patients operated with the Shouldice modified by Berliner repair. Mean operative time was 53,56min for group 1 and 57,32min for group 2 (p=0,2982). In group 1, 94,1% of the patients left hospital within 24h whereas 92,6% did so in group 2 (p=0,8050). There was no surgical mortality and complication rate was 10% in group 1 and 12,5% in group 2 (p=0,5557). Mean follow up time was 3,35 years in group 1 and 3,64 years in group 2 (p=0,2337). Recurrence was 1,2% (0% in primary and 10% in recurrent hernias) in group 1 and 5,4% (4,4% in primary and 12,5% in recurrent hernias) in group 2 (p=0,0935). None of these differences were significant. It was evaluated the recurrence rate in the first and second half of the operated patients and demonstrated significant difference between the two techniques in the first half (p=0,0472) We concluded the Shouldice modified by Berliner repair is similar to the Falci-Lichtenstein in men, over 18 years with type 3 A, 3 B and 4 inguinal 78 hernias of Nyhus classification. When the first half of patients were analized the modified Shouldice presented more recurrences