NON-MESH Hernia Repair – The Updated Shouldice Technique

Most hernias today are repaired with various types of nylon mesh, generically referred to as polypropylene. This is based upon studies that have shown that the insertion of mesh reduces the recurrence rate of hernia surgery to levels between 5% and 10%. However, the Shouldice technique of hernia repair, which does not use mesh, has a failure rate less than 1% in the hands of experts trained in this method.

The popularity of nylon mesh use has unmasked the disastrous complications that result from the inflammatory properties of this type of mesh. The most frequent complication of nylon mesh use in hernia repairs is chronic pain, with several studies demonstrating an incidence as high as 50%. Ultimately many of these patients are forced to undergo additional surgery to extract the mesh. Other reported consequences of this mesh use is migration of the mesh to vital structures, entrapment of the spermatic cord causing exquisite testicular pain, embedding of the mesh into the bladder or the intestines. All of these disastrous findings require complex remedial surgery.

The Shouldice Method of hernia repair was developed in Canada in 1945. This technique of repair uses no mesh as it is based on a tissue repair. Reports from Shouldice Clinic have consistently documented failure rates under 1%, which has made the Shouldice the gold standard in hernia surgery. The procedure is done with a “twilight” anesthesia (sedation), as opposed to a general anesthesia used in other repair methods. Although the original technique using a wire suture is still practiced by them , many centers have upgraded to a synthetic, “stretchy” suture which is better suited to the active adult. Additionally, many Shouldice experts use a two layer of repair as opposed to the four layer originally proposed.

Major advantages of the updated Shouldice Technique is the short duration of surgery – 20 to 30 minutes, a small groin incision, and the ability to return to full activities three days following the repair. As noted above, no mesh is used so that none of the complications associated with nylon mesh are seen. With a failure rate under 1%, it is the procedure of choice for those patients who research the best method of hernia repair.

The Modified Shouldice technique was pioneered by Dr. Grischkan for those patients with either huge hernias or prior failed hernia repairs in which there is extensive damage to the groin so that a tissue repair cannot be performed. In those instances, a Shouldice repair is modified to incorporate a small segment of GoreTex mesh. This allows for a tension free repair and has achieved outstanding results for patients from all over the world. Unlike nylon mesh, GoreTex is virtually inert in the body and does not cause the host of complications known to occur with nylon mesh.

With over 20,000 hernia repairs performed by Dr. Grischkan, you can be assured that you will receive expert advice as to the best method of repair for your hernia.