Shouldice Hernia Repair

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

What is a Hernia?

A hernia is a hole in the muscular abdominal wall. It can be located in many locations.  The most common locations are the groin area (inguinal or femoral hernia) and in the belly button (umbilical hernia).  The hernia can cause discomfort or possibly even emergency issues because of the possibility of the intestine getting caught in and squeezed by the hernia hole.

What is the Shouldice (no mesh) Repair Technique?

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. After many years of studying, observing other experts, and personal experience - I will provide a perfect Shouldice repair for my patients. As I have become expert at the variable three-dimensional anatomy of the inguinal canal - the Shouldice inguinal repair technique is brilliant and proven.

Is the Shouldice Repair Right for You?

While there are many techniques used for inguinal hernia repair - some techniques are best matched with certain types of patients.

While it is not proven, many hernia experts agree that young, thin active people have a higher risk of pain or discomfort in the long term with the use of mesh. At the same time, it is clear that when mesh is used correctly in the right patient there is a lower risk of long term recurrence of the hernia. In expert hands, laparoscopic and robotic techniques of inguinal hernia repair mesh placement has a risk of recurrence and complications of under 1 percent.

Despite our extraordinary results with laparoscopic and robotic techniques of inguinal hernia repair, it remains clear that the avoidance of mesh in some patients eliminates the risk of chronic discomfort or pain and with a small price of a slightly higher risk of recurrence. Therefore a non mesh inguinal hernia repair may be the most "minimally invasive" option.
surgeon in mask

The Shouldice Procedure

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).

Benefits of the Shouldice Technique

  • Repair is performed only with the patient's own tissue. (Natural tissue repair)
  • No synthetic mesh material is used.
  • Avoidance of entry into the abdomen and potential injury to intestine or major blood vessels.
  • Extraordinarily low risk of infection or major complications.
  • Can be performed under local or regional anesthesia.
  • 75 years of experience, safety, and durability demonstrated by the Shouldice Clinic.

What to Expect After Shouldice Inguinal Hernia Repair

The biggest variable after this surgery is the degree of pain after the operation.

90-95% of patients undergoing a Shouldice inguinal hernia repair will experience mild to moderate pain in the first 8-12 hours 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.

Returning to Activities after Surgery ...

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.

Overall - most patients find the Shouldice repair of their inguinal hernia to be a good experience and easily tolerated.

Contact Us Today

At Center for Hernia Repair , we specialize in the treatment of hernias and prioritizing patient comfort and satisfaction.

Dr. Yunis relies on his 20 years of experience and expertise in a variety of repair techniques to offer his patients a customized treatment plan to suit their needs.

Call us at 941-953-5917 to discuss your options.
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FAQs

What types of hernias can be treated with Shouldice repair?
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).
Is mesh better than Shouldice (or no mesh) repair?
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.
How long does Shouldice repair take to perform?
Approximately 1 hour.
How successful is the Shouldice repair method?
Extremely successful. The Shouldice clinic reports a risk of hernia recurrence of under 1%.
How do you determine if I’m right for the Shouldice technique?
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.
Where will you perform the procedure?
At a hospital or surgery center on an outpatient basis.
What do I need to do to prepare for Shouldice hernia repair?
Possibly you will need to optimize your weight.
Will I need to lose weight?
Optimally, one should attain close to ideal body weight prior to surgery.
How much does hernia repair cost?
This varies by location in the world. The cost is typically less than laparoscopic or robotic techniques.

Center for Hernia Repair

1435 South Osprey Avenue
Suite 201
Sarasota, Florida 34239
941.953.5917
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