Shouldice vs Lichtenstein Inguinal Hernia Repair: A Propensity Score-Matched Analysis Comparing Early Postoperative Pain and Quality of Life.

Background: Tissue-based inguinal hernia repairs (IHRs), such as the Shouldice technique, are an acceptable alternative to mesh-based repairs in appropriately selected patients; however, they are often thought to be more painful than tension free repairs in the early postoperative period. We aimed to compare short-term pain and quality of life (QoL) between the Shouldice and Lichtenstein techniques for IHR.

Methods: The Abdominal Core Health Quality Collaborative (ACHQC) database was queried for patients who underwent open IHR between January 2017 and April 2023. Patients who underwent Shouldice repairs were propensity score matched (PSM) to patients who underwent Lichtenstein repairs based on several covariates: age, BMI, ASA class, diabetes, anticoagulation use, smoking, scrotal component, and QoL overall score at baseline. The primary outcome was 30-day QoL as measured by the validated EuraHS survey with overall, pain, and restriction-specific subdomains where higher scores are associated with worse QoL. Additionally, the amount of narcotics taken was evaluated.

Results: A total of 1600 patients underwent IHR by either Shouldice or Lichtenstein techniques. After PSM, 109 patients remained in the Shouldice group, and 183 patients remained in the Lichtenstein group. At 30-days, median overall (13.33 vs. 14, p=0.5), pain (3 vs. 2, p=0.12), and restriction (6 vs. 4, p=0.4) EuraHS scores were similar between the Shouldice and Lichtenstein groups. Patients that underwent Shouldice repairs were more likely to have taken zero opioid tablets than those who had Lichtenstein repairs (68% vs. 55%, p=0.035).

Conclusion: Shouldice repairs demonstrated similar pain and quality of life at 30-days when compared with Lichtenstein repairs. This data should guide shared decision-making discussions when considering which approach to perform in suitable candidates undergoing open inguinal hernia repair.