Does the Use of Polypropylene Instead of Stainless-Steel Wire Affect the Short-Term Recurrence Rate After Shouldice Primary Inguinal Hernia Repair?

Abstract Background Determine if polypropylene is noninferior to stainless-steel wire (SSW) after Shouldice Primary Inguinal Hernia Repair (SPIHR) regarding recurrence rate at ≥ 1-year after surgery. Method A prospective follow-up of SPIHR patients at Shouldice Hospital (SH) from 6/12/2021-1/09/2022, was conducted. Data collection included calls and chart review. Patients were asked about recurrence(s)/recurrent surgery and any observed groin swelling/protrusion. Recurrences were differentiated by confirmed (ultrasound report/documented examination) and not confirmed (report of bulging/swelling and examination outside SH). Results 1120 patients underwent SPIHR (males: 1057; females: 63). The median age and body mass index were 62 years and 25.2 kg/m2. Hernias were more commonly repaired on the right (53.4%) and an indirect inguinal (56.5%). Most patients had American Society of Anesthesiologists (ASA) score II (39.7%, ASAI: 25.3%; ASAIII: 34.8%; ASAIV: 0.2%) and did not suffer from surgical site infection (98%), nor postoperative complications (98.4%). The median duration of surgery in patients with SSW and polypropylene were 47 and 49 minutes (p = .007), and median follow-up was 16- and 17-months (p .001), respectively. Patients with polypropylene had more large hernias (47.1% vs. 25.4%), SSW had more medium (63.6% vs. 41.3%), and incidence of small hernias was comparable (p .001). There were 18 recurrences (1.6%), 11 (0.98%) were confirmed, no difference between SSW and polypropylene (p 0.9). The median month to noting a recurrence was 6, and only one patient underwent reoperation for recurrent hernia 9-months later. Conclusion The use of polypropylene is non-inferior to the use of SSW in terms of the recurrence rate at a median follow-up period of 16 months after elective unilateral SPIHR.