Shouldice Repair of Inguinal Hernias

Shouldice hernia repair is the repair of inguinal hernias without the use of mesh. This technique has improved outcomes from older non-mesh repairs.

This is a unique approach to the repair of inguinal hernias in the groin that avoids the use of mesh. It is an elegant operation involving the sewing of distinct anatomical layers together in 4 layers using a permanent suture. It is a technique developed by Dr. Shouldice as part of an evolution from historic repairs known as Bassini Repairs. The Shouldice repair has improved outcomes over older nonmesh repairs with lower risks of hernia recurrence.

The Shouldice repair has a history of great success for cure of the hernia and minimal risk of injury to the patient.

The Shouldice Clinic outside of Toronto, Canada has demonstrated extraordinary safety and durability with their technique. The technique was designed by Dr.Edward Earle Shouldice and became popular when he opened his hernia hospital in 1945 and his technique has attracted patients from all over the world. To this day - the surgeons at the Shouldice Hernia Clinic - provide extraordinary care for their patients and continue to have excellent results. I do everything possible to uphold their standards in performing the Shouldice inguinal hernia repair.

At Center for Hernia Repair in Sarasota, Florida, we proudly offer the Shouldice inguinal hernia repair technique to our patients. 

Shouldice repair of inguinal hernias begins with a thorough exposure and evaluation of the inguinal anatomy. The initial appearance of the tissue in an inguinal hernia repair is confounded by the various appearances of herniated tissue protruding through the hernia. The appearance is often further distorted by long term inflammation which alters the appearance of what the surgeon is seeing. It is for this reason, that years of training and experience are necessary for a formal Shouldice repair of an inguinal hernia.

After expert exposure of the inguinal anatomy, the surgeon can then proceed with the repair of the hernia.

1- The surgeon evaluates for all possible hernias in the area (direct and indirect inguinal, femoral, and interstitial hernias).
2- The posterior wall (Transversalis fascia) of the inguinal canal is opened. This is necessary to define and expose the layers needed for reconstruction.
3- Four distinct anatomical layers are sewn together with wire or a permanent suture. The surgeon's experience is critical in identifying the unique anatomical layers that are sewn back together. Expertise is required to avoid injury to surrounding vital structures and nerves (neurovascular structures to the leg and testicle).

90-95% of patients undergoing a Shouldice inguinal hernia repair will experience mild to moderate pain in the first 2-3days after surgery.  These patients are frequently able to avoid prescription pain medicine after surgery.

5-10% of patients will experience significant pain requiring prescription pain medicine.

99% of patients are comfortable at rest within 5 days of the operation and tolerate symptoms with ibuprofen and /or acetaminophen alone.

Return to office type job within 3-5 days after surgery depending on level of discomfort.

Return to 30 lb lifting as soon as you feel comfortable.

Return to extraordinary physical activities performed by high performance athletes and those with physical demanding occupations is dependent on multiple factors and is not uniform for all.

Learn more about what to expect after hernia surgery.

The Shouldice repair is a type of natural tissue repair of inguinal hernias that occur in the groin (the lowest part of the abdominal wall).

The Shouldice repair of inguinal hernia is a natural tissue repair that does not use mesh. While the Shouldice repair has demonstrated over 75 years of excellence, there is extensive evidence that shows that the use of mesh yields a lower risk of hernia recurrence than natural tissue repairs.

Approximately 1 hour.

Extremely successful. The Shouldice clinic reports a risk of hernia recurrence of under 1%.

The Shouldice repair can be performed on patients that are close to ideal body weight and have not had their hernia repaired before. Some patients with prior repairs are candidates for Shouldice repair.

At a hospital or surgery center on an outpatient basis.

Possibly you will need to optimize your weight.

Optimally, one should attain close to ideal body weight prior to surgery.

This varies by location in the world. The cost is typically less than laparoscopic or robotic techniques.