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The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres.

Three hundred patients with primary inguinal hernia were randomized to either a Shouldice repair or to a tension‐free Lichtenstein repair. In a pretrial training programme the five participating general surgeons were taught to perform the two techniques in a standard manner. Follow‐up was performed after 8 weeks, 1 year and 3 years. The last examination was performed by an independent blinded assessor.

There was a significant difference in operating time in favour of the Lichtenstein technique. After a follow …