Shouldice Repair

The Iskandar Complex Hernia Center is proud to offer our patients a proven and remarkable approach to hernia repair, the Shouldice inguinal hernia repair technique. Shouldice repair is an innovative method for treating inguinal hernias without the use of mesh. It is a surgical procedure that involves utilizing a permanent surgical suture to stitch four separate anatomical layers together.

Shouldice hernia repair is a method that Dr. Shouldice created as an evolution from earlier procedures known as Bassini Repairs. Shouldice repairs provide better results than earlier non-mesh repairs and decreased hernia recurrences.

With little risk of harm to the Shouldice patient, the technique has a long history of curing hernias. Dr. Iskandar, a renowned expert in hernia repair, is pleased to offer patients this option for the treatment of inguinal hernias. Don’t let a hernia affect your quality of life any longer. Contact our friendly team today for more information and to schedule your appointment with Dr. Iskandar.

Shouldice Repair Benefits

  • The only tissue used for repair is the patient’s own (natural tissues).
  • There is no use of synthetic surgical mesh material.
  • Does not enter the abdomen to prevent possible damage to the intestine or major blood vessels.
  • Extremely low chance of serious complications or infection.
  • It can be carried out under regional or local anesthesia.
  • The Shouldice Clinic has demonstrated the procedure’s durability and safety with 75 years of experience.

How is a Hernia Repaired with the Shouldice Repair?

An evaluation of the inguinal anatomy is the first step in the Shouldice repair of inguinal hernias. The many ways in which herniated tissue might protrude through the hernia can confuse the initial appearance of the tissue during inguinal hernia surgery. Long-term inflammation frequently further distorts the look, altering what the surgeon can perceive. A well-trained surgeon will also find and repair any secondary hernias to prevent the need for future surgeries.

Because of this, a formal Shouldice repair of an inguinal hernia requires years of training and experience. During a Shouldice repair, once the surgeon has exposed the inguinal anatomy, they can then move on to the hernia repair.

1- The surgeon examines the area for any potential hernias (direct and indirect inguinal, femoral, and interstitial hernias).

2- The posterior wall of the inguinal canal (Transversalis fascia) is opened. This is required to identify and reveal the layers that are required for reconstruction.

3- Permanent suture is used to join four separate anatomical layers. In order to recognize the distinct anatomical layers that are sewn back together, the surgeon’s experience is essential. To prevent harm to adjacent important structures and nerves, expertise is needed (neurovascular structures to the leg and testicle in groin hernias).

Dr. Iskandar is a highly trained physician with vast experience and knowledge in complex hernia repair. He combines his expertise with compassionate care to give patients the best experience possible when having a Shouldice surgical procedure.

Experience renowned expertise and unparalleled compassion from the leader in hernia repair.

More FAQ’s about Shouldice Repair

What kinds of hernias can the Shouldice repair treat?

Most inguinal hernias can be treated using the Shouldice repair.

What is a hernia?

An opening in the muscular abdominal wall is known as a hernia. It can be located in a variety of places. The belly button (umbilical hernia) and the groin area (inguinal or femoral hernia) are the most common locations. The hernia can be painful or even life-threatening if the intestine becomes trapped in the opening and is compressed.

The inguinal ligament is a pair of bands that runs deep within the groin and joins the pelvis to the external oblique muscles of the abdomen. They stabilize the pelvis and abdomen and support the groin’s soft tissues. In this area of the body, an inguinal hernia is a common issue.

Who should have a Shouldice repair?

While there are various techniques utilized to treat inguinal hernias, some methods work best for particular types of patients.

Although it has not been proven, many hernia specialists concur that young, active persons who are slender and athletic are more likely to have pain or discomfort after mesh surgery. However, it is also undeniable that the chance of a hernia recurring over time is reduced when mesh is utilized appropriately and on the right patient. Laparoscopic and robotic inguinal hernia repair procedures performed by qualified surgeons carry complication rates of 1% and the same for recurrence.

Despite our remarkable success rates with laparoscopy and robotic inguinal hernia repair, it is nevertheless evident that in some patients, avoiding mesh reduces the likelihood of chronic pain or discomfort at the relatively minor cost of a slightly increased risk of recurrence. Therefore, Shouldice techniques (non-mesh inguinal hernia surgeries) might be the most “minimally invasive” alternative for these patients.

How long does it take to complete the Shouldice repair?

The procedure typically lasts approximately 45 minutes to one hour.

Is there pain after having the Shouldice repair procedure?

In the first 8 to 12 hours following surgery, mild to severe discomfort will be experienced by 90–95% of patients having a Shouldice inguinal hernia repair. After surgery, these individuals typically have no need for prescription pain medication.

5–10% of patients will experience severe pain that needs to be treated with pain medications.

Within 5 days of surgery, 99% of patients can handle their symptoms with just ibuprofen and/or acetaminophen.

How long is the hospital stay following a Shouldice repair?

The Shouldice hernia repair is done as an outpatient surgery, and patients should be able to go home within a few hours of their procedure.

What are the restrictions after a Shouldice repair?

One month after surgery, there are no restrictions on lifting heavy weights. As soon as you are able, we advise getting back to normal activity levels again. If your job isn’t too physically demanding, you might be able to return to work in less than a week, or you might be assigned to light duty for a short while. As soon as you’re able, you can start playing sports and exercising again.

You are the best judge of when and how much you should do as you listen to your body. It is really challenging to undo the repair, so that is why the restrictions are less with this type of procedure than with others. A Shouldice repair is perfect for labor-intensive jobs and athletes.

The Shouldice repair is intended to restore your muscle function so that you can perform your duties. Each patient’s return time to their previous level of normal can vary from four to eight weeks, but you are undoubtedly active in the interim until you feel you are back where you need to be. Your body is still recovering during this time, even though you have resumed your normal activities.

That means that as you are returning to work, exercise, muscular conditioning for competitive sports, and moving toward your previous job responsibilities, you should keep in mind that you had surgery and your body still may need time to heal.

Will I need to lose weight prior to having a Shouldice hernia repair?

Ideally, you should try to achieve your optimal body weight prior to surgery. Every person’s body is unique, so Dr. Iskandar will discuss with you what would be the best plan for your particular situation.

Are mesh repairs better than non-mesh repairs?

The Shouldice inguinal hernia repair uses natural tissue repair without the need for mesh. Despite the Shouldice repair’s 75 plus years of success, there is compelling evidence that mesh-based surgical techniques have a lower risk of hernia recurrence than natural tissue repairs.

How successful is the Shouldice repair?

The Shouldice hernia repair technique is extremely successful. The recurrence rate is less than 1%, according to the Shouldice Hernia Centre in Ontario, Canada.

What are the benefits of receiving Shouldice repair treatment at the Iskandar Complex Hernia Center?

Dr. Iskandar, a renowned expert in complex hernia repair, has extraordinary experience in performing Shouldice repair. Medical literature has shown that experience matters greatly when it comes to treating hernias. The Shouldice repair is a comparatively challenging technique. The observed recurrence rates are, however, quite low when performed by hernia surgeons who are experienced with this specific technique.

Dr. Iskandar is one of the leading complex hernia experts in the United States, and his training has allowed him to develop his skills and focus on his passion for bariatric surgery, complex abdominal wall reconstruction, and hernia surgery. Dr. Iskandar is passionate about improving the quality of life of his patients by providing compassionate care in the treatment of hernias. To find out if the Shouldice repair or another hernia repair technique is right for you, schedule your physical examination with Dr. Iskandar by contacting The Iskandar Complex Hernia Center now.

Posted on December 20, 2022

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Dr. Iskandar, MD, FACS is a board-certified general surgeon with fellowship training in minimally invasive surgery and bariatric surgery. He is an accredited Surgeons of Excellence in Hernia Surgery by the SRC. The Iskandar Complex Hernia Center is one of only two North Texas Hernia Centers deemed Centers of Excellence. As a globally respected complex hernia expert, he specializes in complex hernia repair and abdominal reconstruction. He is also an Associate Professor of Surgery at Texas A&M School of Medicine.