The Centre of Excellence for Hernia Repair

The global leader in external abdominal wall hernia surgery for over 65 years

The Shouldice Hernia Repair

The Shouldice repair is internationally recognized as one of the safest and most effective techniques for repairing hernias. When performed by a specially trained and well-experienced Shouldice surgeon, this pure, natural tissue repair virtually eliminates complications or repeat hernias (recurrences). For over 65 years, we have maintained a success rate of 99.5% on primary inguinal hernias – an accomplishment that sets us apart from any other medical facility.

The operation was a lot like going to the dentist. They have soft rock radio playing. A local anaesthetic is used to numb the area and then they go to work. I really didn't feel anything except a little pulling and tugging. I spent the 30 minutes of the operation chatting with the nurses. . . . They closed me up with clips, and I actually got up and walked out of the OR to a wheelchair waiting in the hallway.

Mike - Boston

What is the Shouldice repair?

The Shouldice repair combines a proven surgical technique with the powerful benefits of the body’s own natural healing ability. This results in a secure, reliable repair and a rapid, comfortable recovery for our patients.

Almost all of the hernia repairs at Shouldice are done using only a local anaesthetic, a sedative (sleeping pill) and an analgesic (pain pill), which adds to the safety of our technique. This approach reduces surgical complications, improves recovery and ensures that our patients are comfortable during surgery. Additional medication may be used when necessary or, in some cases, a general aesthetic may be required.

Most importantly, while working at Shouldice every surgeon on the Shouldice team focuses their professional time, training and expertise on the successful lifelong repair of external abdominal wall hernias. On average, Shouldice surgeons performs up to 700 hernia operations a year, giving them the experience and skills to expertly manage even the most complex hernia repair. In total, the Shouldice surgical team has performed well over 360,000 hernia operations to date. When it comes to successful hernia repairs, there is simply no substitute for experience.

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Shouldice surgeons do more repairs in two years than most of their counterparts do in a lifetime.

Washington Post

The operation

The muscles and connective tissue Connective tissue surrounds, supports and may connect muscles, organs and other parts of your body. of the abdominal wall are arranged in three separate layers. Before repairing any weakness, we gently place the fatty tissue and any part of the intestine (bowel) that may have bulged through the abdominal wall back inside the abdomen. Then we repair each muscle layer individually, using a technique that puts no tension on the natural tissue. By carefully overlapping and securing each layer, just like you do when you button a coat, we strengthen and reinforce this section of the abdominal wall.

As part of the Shouldice procedure, we do a thorough search for other hernias in the area and repair them, too. This aspect of our technique is unique and not commonly practiced elsewhere as a routine. Research has shown that up to 13% of people with hernias have a second weak spot in their muscles or a “hidden” hernia. Our skilled surgeons have the time and expertise to find these hidden threats – in fact, it’s one of the most important benefits of the Shouldice repair.

If a secondary hernia is not revealed during surgery, it may lead to another operation to repair it, increasing your risk of complications and future recurrences.

At Shouldice, we firmly believe that it is in the best interests of our patients to cure hernias permanently by finding and repairing all secondary hernias.

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The recovery

Hernia Recovery

Your recovery begins the moment your operation is over. Patients are actually able to walk out of the operating room, assisted by your surgical team. By the next morning, you’ll be up and about, doing gentle exercises along with all the other patients. During your recovery, you’ll receive a holistic program of patient care that encourages a safe, healthy and rapid return to normal activities. Most of our patients are back to their regular routines in less than a week and some even go back to work as soon as they are discharged from the hospital.

Our repair techniques have been widely acclaimed but it is the total Shouldice experience that underlies our success and attracts patients from around the world to our hospital. Learn more about the Shouldice experience

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Other hernia repair techniques

In addition to natural tissue repairs, there are two other main types of hernia repair:

Mesh repair – There are many different types of mesh repairs. The common characteristic is the dependence on mesh, an artificial foreign material, to address the hernia. Instead of an actual anatomical repair, a mesh implant is placed over or in the hernia defect to “patch” or “plug” the opening in the muscle and connective tissue. The repair depends on scar tissue to grow into the mesh, forming a large layer of scar tissue. As the scar tissue shrinks, so does the mesh, creating a fibrous mass, which is often associated with chronic or long-term complications in mesh surgery.

Not every hernia can be repaired with a natural tissue technique. Shouldice surgeons have the expertise to perform a mesh repair but use it only in special cases, such as when the natural tissue has been destroyed by earlier surgical repairs at other hospitals. In these cases, the mesh is introduced as part of a Shouldice hybrid technique. Over 95% of our repairs are pure natural tissue, with no mesh implants required.

Any hernia repair may cause complications for the patient. However, mesh repairs are associated with additional complications if an infection develops around the implant and the mesh has to be removed. Mesh can also be troublesome in later years for men if urological or prostate surgery is required. Mesh repairs have not demonstrated better results for the patient than a natural tissue repair performed at Shouldice Hospital, and the recovery time for both techniques is very similar.

Laparoscopic hernia surgery – This type of surgery is performed under general anaesthetic. Three small openings are made in the abdomen. Then, the abdomen is filled with gas (carbon dioxide), so that the surgeon can see the abdominal organs through Instruments which display the images on a TV screen. Other instruments are inserted through the openings and used to insert the mesh and staples or screws used to anchor the mesh in the repair of the hernia. Mesh must be used to reinforce the abdominal wall.

Although a laparoscopic repair is described as minimally invasive it does require three incisions and deep surgical intervention. Fatalities have been associated with this technology and as a result it has also been removed from some insurance malpractice trusts. We do not perform this type of repair at Shouldice Hospital.

Low risk, proven success and no artificial or foreign material implants are three reasons why many patients prefer a pure, natural tissue Shouldice repair over a mesh repair or laparoscopic mesh surgery.
“Time and results are our guides.”

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Did you know?

Studies show that 13% of hernia patients have secondary hernias that are discovered during surgery. Finding and repairing these hidden hernias is one of the main reasons why the Shouldice hernia recurrence rate has been the lowest in the world for over 65 years.

Arrange for an examination or operation

Whenever possible, we recommend that you visit our clinic for a diagnosis.