Hernia (1999) 3: 117-12o Hernia 9 Springer-Verlag 1999 Papers Gold standard for inguinal hernia repair: Shouidice or Lichtenstein? F.H. Hetzer ~, T. Hotz:, W. Steinke 2, R. Schlumpf ~, M. Decurtins: and F. Largiaded 1Department of Surgery, University Hospital, Zurich Switzerland 2Kantonsspital, Winterthur Switzerland Summary: In the knowledge that Lichtenstein inguinal hernia repair is beco- ming increasingly popular we evaluated this technique in a prospective ran- domized study. Would the Lichtenstein repair show significant advantages in order to justify it replacing the Shouldice technique, the standard for hernia repair of the last ten years? Between January 1996 and December 1997 the study was undertaken on 385 male patients suffering from 41o primary ingui- nal hernias. On 164 patients the Shouldice technique (SD) was used and on 221 patients the Lichtenstein repair (LS). 5o % of the operations were perfor- med under local anesthesia, 5o % under spinal anesthesia. The 41o operations were done by 51 different surgeons, most of them in trainee programs. The postoperative local complication rate and duration of hospitalization were similar in both groups. Significant differences were noted concerning opera- tion-time (LS: 8o min, SD: 88 min, p < o,oos) and return to work (LS: 25 days, SD: 41 days, p < o,oooo5). The tension-free repair under local anesthesia des- cribed by Lichtenstein is an easy operation, with a low complication rate and short recovery period. The Lichtenstein technique is an ideal hernia repair with low costs, high patient comfort and suitability for day-surgery. Key words: Hernia repair -- Lichtenstein technique -- Shouldice technique Corrrespondence to: F. Hetzer Received March 29, 1999 Accepted in final form May 12, 1999 More than ten years ago in the clinics of visceral surgery of the University Hospi- tal in Zurich and Kantonsspital Winter- thur the technique of hernia repair by Bassini [Bassini 189o] was replaced by the Shouldice technique, which showed better results in the literature [Schumpe- lick 1984]. Two reasons among others for the replacement were a shorter hospital stay (5-3 vs 6.6 days) and the reduction of the recurrence rate (1% vs lo.9%) [Hoff- mann 1991]. Meanwhile the Shouldice technique has become the ~Gold Stan- dar&~ for all primary unilateral inguinal hernias. During 1994 in Switzerland, 87oo surgical interventions for primary inguinal hernia are reported [Herzog 1996]. 46.4% were repaired using the Shouldice technique, followed by the ~transversalis plasty, described by Bar- well (45.2%) [Barwell 1981], which is just a simple modification of the Shouldice repair. The complex endoscopic proce- dure has made some progress in the last few years, but remains a reserved field for experienced surgeons and requires general anesthesia. In view of the high