AUTHOR=Lorenz R. , Arand S. , Conze J. , Fortelny R. , Kilk K. , Koch A. , Köckerling F. , Mayer F. , Pokorny H. , Riediger H. , Wiese M. , Hukauf M. , Wiessner R. 
  
TITLE=Shouldice versus Lichtenstein repair for recurrent groin hernia following laparo-endoscopic repair: a propensity score–matched analysis of the herniamed registry
  
JOURNAL=Journal of Abdominal Wall Surgery
  
VOLUME=Volume 5 - 2026
  
YEAR=2026
  
URL=https://www.frontierspartnerships.org/journals/journal-of-abdominal-wall-surgery/articles/10.3389/jaws.2026.17769
  
DOI=10.3389/jaws.2026.17769
  
ISSN=2813-2092
  
ABSTRACT=BackgroundInternational guidelines recommend an anterior mesh-based Lichtenstein repair for recurrent groin hernias following previous laparo-endoscopic repair. Whether the mesh-free Shouldice technique provides comparable outcomes in this setting remains unknown. This study compared perioperative and one-year outcomes after Shouldice and Lichtenstein repair using data from the Herniamed Registry.MethodsAdult patients undergoing elective repair of a first unilateral recurrent groin hernia after previous laparo-endoscopic repair were identified from the Herniamed Registry. Patients treated with either Shouldice or Lichtenstein repair and with complete one-year follow-up were eligible. A 1:1 propensity score matching was performed using demographic, clinical, hernia-related, and operative variables to minimize baseline differences. All outcome variables such as intraoperative, postoperative and general complications, complication-related reoperations, surgical site complications, hernia recurrence at 1 year and patient-reported pain outcomes at 1 year were analysed in this study.ResultsOf 12,498 eligible patients, 253 underwent Shouldice repair and 12,245 underwent Lichtenstein repair. Propensity score matching yielded 248 well-balanced patient pairs. No significant differences were observed between the two procedures regarding one-year recurrence, intraoperative or postoperative complications, complication-related reoperations, postoperative haemorrhage, seroma, surgical-site infection, or patient-reported pain outcomes after adjustment for multiple testing. Pain on exertion at 1 year was reported less frequently after Shouldice repair than after Lichtenstein repair (18.5% vs. 27.0%; P=0.031), although this difference did not remain statistically significant after Bonferroni correction.ConclusionIn this propensity score–matched registry analysis, no statistically significant differences in perioperative and one-year outcomes were detected between Shouldice repair and guideline-recommended Lichtenstein repair for first recurrent groin hernias following previous laparo-endoscopic repair. Given the small number of Shouldice procedures and the wide confidence intervals, clinically relevant differences cannot be excluded. In carefully selected patients and when performed by experienced surgeons, the Shouldice technique may nevertheless represent a mesh-free option. Larger comparative studies with long-term follow-up are required to confirm these findings and further define its role in the management of recurrent groin hernia.