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FAQs about the Shouldice Hernia Repair


*** Testimonials of Patients Having a Shouldice Repair at Stony Brook ***

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Dr. Samer Sbayi

Have you ever wondered what that bulge is in your groin, belly button, upper belly, or at the old scar in your belly?

Have you had it checked by a physician? Did a relative or friend tell you it might be a hernia?

Did you know you can have a hernia repaired by a procedure with a low complication rate, with slim to no chance of the hernia ever coming back, very low chronic pain rate, and no need for mesh?

Maybe you have heard that someone had a hernia repaired but it came back, or they had ongoing pain after the repair. Finding good answers to questions about hernias and the different methods of repairing them can be a challenge.

Here, Samer Sbayi, MD, assistant professor of surgery, of our Bariatric, Foregut, and Advanced Gastrointestinal Surgery Division, answers frequently asked questions about hernias and the famous Shouldice repair. An experienced Shouldice-trained surgeon, Dr. Sbayi has to date performed the Shouldice procedure for over 650 patients.

Q: What is a hernia?

A: A hernia is a weakness in your abdominal muscles that allows for a bulge that you may or may not see.

Sometimes what prompts a clinical exam by the doctor is pain, or a vague ache. This will likely compromise your ability to do the normal physical activity that you normally can accomplish.

Your employer will likely be very concerned in your ability to do your job successfully in your current condition, and will encourage you to have this taken care of or at least examined by a surgeon. You may actually be put on leave till this is addressed to their satisfaction.

We don't know the reasons for the weakness in the muscle that generates this condition, but we are very good at diagnosing it. You may need further imaging with an ultrasound or another x-ray like a CT scan to better see what is going on.

Q: How are hernias repaired?

A: Repairs, however, are many, and mostly use mesh (or a screen or patch). They can be laparoscopic (small-hole surgery with camera) or just an open procedure with one incision. Recurrence rates can vary from 4% to higher than 15%. The same also goes for chronic pain after the repair. Your surgeon should discuss this possibility as part of the consent process.

Q: Is it possible to live with a hernia and avoid repair?

A: Yes, but it may not appeal to your liking when you look in the mirror. More important, it will likely compromise your daily activity, prevent you from keeping your job because of your inability to complete your tasks, and prevent you from playing with your children or grandchildren, or participating in extracurricular activities, competitive and non-competitive. And you may be at risk of it progressing and strangulating, which can be very dangerous. Strangulated hernias can be fatal; they are surgical emergencies.

The Shouldice repair has proven to be exceptionally safe, secure, and reliable.

Q: What is the Shouldice hernia repair?

A: The Shouldice repair is named after Dr. Edward Earle Shouldice (1890–1965), the Canadian surgeon who invented the technique in the 1940s. The repair is based on the Bassini repair with some modification. The Bassini repair, named after Dr. Edoardo Bassini who developed it in the 1880s, was the first efficient repair for inguinal hernia.

Dr. Shouldice developed his repair during World War II to help men who were unable to enlist in the military because of their hernias. His method improved surgical results and reduced recovery time, quickly restoring the recruits to physical fitness for military training.

The procedure involves repair of your muscles using permanent sutures (no mesh, patch, or screen). It is done with intravenous sedation, not gas anesthesia. It is also done with local anesthetic injected into the skin to numb up the surgical site during and for a few hours after the surgery.

Q: Why do patients seek out the Shouldice repair?

A: It is performed with no mesh. Very few cases would require mesh. The repair also provides quality measured by low recurrence, low chronic pain, and low infection rates.

In fact, at Shouldice Hospital where I was trained in the procedure, the recurrence rate is only about 1% and the chronic pain rate is 3 in 1,000 patients at 3 years and 6 per 1,000 patients at 10 years follow-up. The infection rate is about 0.3%.

Q: What types of hernias can be treated with the Shouldice repair?

A: The Shouldice repair is used to treat a variety of external abdominal wall hernias, including indirect and direct inguinal hernias, recurrent hernias, femoral hernias, epigastric hernias (also called ventral hernias), incisional hernias, Spigelian hernias (also called lateral ventral hernias), and umbilical hernias.

There are other types of hernia for which the Shouldice repair is not used, such as hiatal hernias and parastomal hernias. These are treated in other ways.

The Shouldice repair is associated with low rates of recurrence and chronic pain.

Q: How long does the Shouldice repair take to perform?

A: Generally, the surgery takes about 45 minutes.

Q: Is there pain after having the procedure?

A: The pain after surgery is managed with over-the-counter Tylenol and ibuprofen. This surgical pain improves each day and significantly lessens the further out you are from surgery.

Q: How long is the hospital stay following a Shouldice repair?

A: We plan to discharge patients the same day of their surgery, avoiding a hospital stay.

Q: What are the restrictions after surgery?

A: There are no weight or lifting limitations after surgery. We recommend getting back to activity as soon as you are able. You may return to work in less than a week if it isn't a very laborious job, or be set up for light duty for a short period of time. You can return to exercise and sports as soon as you are able.

Yes, you judge when and how much you can do. Yes, it is very difficult to break the repair. Yes, this is ideal for athletes and very labor-driven jobs.

The Shouldice repair is meant to recover your muscle function to do what you need to do. Recovery back to what normal used to be for each individual patient can vary from four to eight weeks, but you are certainly active in the interim until you feel you are where you need to be. Although you may resume activities during this time, your body still continues to recover.

That means you are back to work, exercise, muscle conditioning for competitive sports, and progressing back to normal work duties. Remember, you had surgery and need some recovery time.

Q: Does body weight affect a hernia repair?

A: Yes. The Shouldice repair has demonstrated continued success for over 70 years as practiced at Shouldice Hospital in Canada, if the patient has acceptable weight for their height. Weight is a very important factor.

If the patient's body frame is large, we can relax on the increased weight, but if it is small, then weight becomes a problem.

Small body frame in and of itself isn't an issue for the repair, but is looked at when examining a patient's weight. Hence, small body frame and not overweight is encouraging, but small body frame and overweight needs to have weight loss.

Large body frame better distributes the body weight because of the larger frame, but weight is still strongly considered during the discussion.

Overweight poses a potential risk for recurrence, bleeding, infection, and chronic pain. The following table used at Shouldice Hospital (founded by Dr. Shouldice) shows ideal weights for height and body frame size:

For Men
   
Body Frame Size
Height
Small
Medium
Large
5'2"
148 lb
155 lb
166 lb
5'3"
150 lb
158 lb
170 lb
5'4"
152 lb
161 lb
174 lb
5'5"
155 lb
164 lb
178 lb
5'6"
158 lb
167 lb
182 lb
5'7"
161 lb
170 lb
186 lb
5'8"
164 lb
173 lb
190 lb
5'9"
167 lb
176 lb
194 lb
5'10"
170 lb
180 lb
198 lb
5'11"
174 lb
184 lb
202 lb
6'0"
178 lb
188 lb
207 lb
6'1"
182 lb
192 lb
212 lb
6'2"
186 lb
197 lb
217 lb
6'3"
190 lb
201 lb
221 lb
6'4"
194 lb
205 lb
225 lb
6'5"
198 lb
209 lb
229 lb
6'6"
204 lb
221 lb
233 lb
6'7"
208 lb
225 lb
237 lb
    For Women
   
Body Frame Size
Height
Small
Medium
Large
4'10"
125 lb
136 lb
147 lb
4'11"
128 lb
139 lb
150 lb
5'0"
131 lb
142 lb
153 lb
5'1"
134 lb
145 lb
157 lb
5'2"
137 lb
148 lb
161 lb
5'3"
140 lb
151 lb
165 lb
5'4"
143 lb
154 lb
169 lb
5'5"
146 lb
157 lb
173 lb
5'6"
149 lb
160 lb
177 lb
5'7"
152 lb
163 lb
180 lb
5'8"
155 lb
166 lb
183 lb
5'9"
158 lb
169 lb
186 lb
5'10"
161 lb
172 lb
189 lb

Use this online calculator to determine your frame size.

Q: What is the advantage of having a Shouldice repair done at Stony Brook Medicine?

A: Our hernia specialists at Stony Brook have extraordinary experience in performing the Shouldice repair. When it comes to fixing hernias, experience makes a big difference, as demonstrated in the medical literature.

The Shouldice repair is a relatively difficult reconstruction. But it has relatively low reported recurrence rates in the hands of surgeons experienced with this particular method.

At Stony Brook, we also have a multidisciplinary team that includes weight loss specialists who provide a range of proven treatments, both non-surgical and surgical. This is important for hernia patients because having a reasonable weight contributes to the success of the hernia repair.

Dr. Sbayi provides online education sessions, via Skype, to go over the whole process of the Shouldice repair and answer questions about it. Sessions can be arranged to take place on the first and third Monday of every month. To arrange for a session, interested parties should call 631-638-0054.

Learn more about the hernias treated with the Shouldice repair. For consultations/appointments with our hernia specialists, please call 631-638-0054. Fill out and fax questionnaire about your health history prior to your visit at the Stony Brook Hernia Center — and save time.

Comments

Would you recommend repairing an inguinal hernia before pregnancy or after? How long would you have to wait to try and conceive after surgery? What is the risk of recurrence? I am currently 91 pounds. Could the hernia increase in size with pregnancy?
You raise important questions about women and abdominal wall hernia repair. Despite their ability to become pregnant, and gain at least 20 pounds during pregnancy, women without a hernia would not be exposed to a lifetime risk on average of more than 2-3%. All comers who undergo any surgery usually have maximal healing by 6-12 months. Hernia surgery is mostly elective, but when diagnosed, elective repair should be planned. I have had competitive athletes repaired who were back to full contact sports at full capacity by 6-8 weeks. They usually reach that gradually in the weeks immediately after surgery. And yet the documented recurrence of the Shouldice repair out of Shouldice Hospital is 1.15% based on a paper last year by an academic surgeon at the University of Toronto who does not operate at Shouldice Hospital. That paper looked at the hernias specifically repaired at Shouldice versus hernias repaired at other hospitals in Ontario which had a recurrence rate starting at 4%. This should hold equally true for a woman who wishes to conceive after hernia repair. A woman with pre-pregnancy hernia who gets pregnant may, however, possibly endure increased size, pressure, pain, and serious problems like incarceration or even strangulation (an incarcerated hernia can cut off blood flow to part of your intestine, while strangulation can kill the affected bowel tissue and is a life-threatening condition that requires immediate surgery). I don't think anyone has been able to predict the exact behavior. However, this holds true for anyone with a hernia who is in the waiting period for hernia repair, all comers. The risk of bowel strangulation, which isn't very common, is around 1%. Given this information, I would recommend examination, then discussion after confirmation of your hernia, and a discussion about repair prior to pregnancy. If you have a femoral hernia (bulge in upper part of thigh near groin), I would recommend proceeding sooner with surgery compared to the other inguinal hernias, as these usually present as incarcerated (stuck, not reducible, but not strangulated) and may cause more symptoms the longer you wait. Hopefully, this long response provides you with enough information to proceed with planning your next steps. Please feel free to call my office during business hours if you wish to discuss further (631-444-8330) or make an appointment to be seen if you live nearby. I am happy to discuss any other questions through the blog as well. If you have worsening symptoms of very dramatic pain, please head to the nearest emergency department to be examined by a physician. — Samer Sbayi, MD
Thank you for the information. I have spoken with a few different surgeons and I have been told I would have to wait 4 weeks, 3 months and 1 year to try and conceive. Seems like every surgeon gives you a different wait time. I realize it is very dependent on an individual basis and how one recovers. I am definitely on the fence about repairing the hernia now or latter. However, the groin discomfort and lower back pain are starting to bother me and causing me to wake-up during the night. However I am going to be 37 and don't want to put off kids much longer. Decisions, decisions, decisions. How long would you recommend a woman wait to conceive after a repair using the Shouldice method? Also, do you have any stats regarding chronic pain associated with the Shouldice repair?
Yes, for the number of surgeons and the repairs available, you may find an equal number of opinions. Having said that, being a laparoscopic surgeon, whose training was laparoscopic hernia repairs, then experiencing the "pure tissue repair" at Shouldice Hospital in Canada, I believe I have found an additional option to provide my patients in the USA. The comforting piece is that the technique which I practiced while at Shouldice has been around for over 75 years. They perform over 7,000 repairs per year, enough to demonstrate that it works. And so I have no qualms in making this repair available because it is a very good and reliable repair. We measure this in terms of recurrence rate (1.15%) and chronic pain which is 3 in 1,000 patients at 3 years and 6 in 1,000 patients at 10 years follow-up. The infection rate is about 0.3%. I have also consulted with colleagues who have more experience with women and hernias and pregnancy: at preconception, repair early, preferred pure tissue repair, and may conceive starting about 2 months after surgery; and during pregnancy, better to wait for repair if possible. Hope this helps. — Samer Sbayi, MD
Dr. Sbayi, I am looking for a surgeon to perform the shouldice method to repair my inguinal hernia, however, I am currently pregnant. I want to get this surgery done as soon as possible post delivery. I live in St. Louis, Missouri so I am wondering if it would be possible to plan a consultation and surgery all in one visit so I am not having to make two trips away from my newborn child. I have been seen by a surgeon here, however, he uses mesh to repair hernias and I haven't found any surgeons remotely in my area that uses the shouldice method of repair. Would it be possible for me to make one trip in order to do this?
Dear Sheenah: Thank you for reaching out. I do perform the Shouldice hernia repair. We can certainly make it on one visit. You will likely have to stay in town for 2 nights. I would have to see you the day before surgery for a consultation. Then you would have surgery the following day. And then sleep one more night. I would reevaluate to the following day before you fly out. In preparation for the surgery, we would need to connect by phone and ask you some questions with regard to your medical and surgical history. I'd have to know what your height and weight are to ensure that you are the appropriate weight for your height in order to have a successful Shouldice repair. I also need a note from your primary care provider indicating that you would be a good candidate for IV sedation and possible general anesthesia. I would also like to have a copy of the surgical consultation hometown. I do have to mention that I would not definitely decide on surgery unless I have seen you in person and confirmed that a hernia does exist. In some rare circumstances during my experience at Shouldice, we have had to turn people away who have come from a distance and actually did not have a hernia on examination. Since this is very unlikely and not common, the risk of that is very low. My contact number is 631-638-0054. This would give you an opportunity to ask questions. I look forward to your phone call. — Samer Sbayi, MD
This was a fascinating read. I had no idea that these kinds of options were available for problematic hernias. Considering how troublesome hernias can be when dealing with your everyday life, it is really nice to know that there is a fix for them. I should really talk to my father about some of these options, since he's been pretty fearful lately that he might be developing a hernia.
Hi. First of all let me say how pleased I am that a surgeon is promoting a non mesh pure tissue repair for hernias and the shouldice repair nonetheless. In a mesh dominated society it is very hard to find a surgeon in the US who still does and has expertise in pure tissue repairs. I have a little bit of a difficult case. I had laparoscopically placed inguinal mesh placed 6 years ago, and what turned out to be a large hematoma that formed about about 7 days later that landed me in the ER. Needless to say I never felt right since and on average about twice a year I'd have the flare ups in my lower abdomen with heaving swollen feeling. It would eventually subside with time. However this past February I experienced pain and burning in the ground that was crippling. I missed a lot of work and all the tests (cat scans and MRI's) came back normal. Two separate visits to two promnant hernia surgeons who both said they couldn't find anything wrong with me and sent me off to pain management. I was left on my own to be my own advocate-instinctively I knew something was wrong with the mesh. I eventually through tons of research found a few surgeons who specialize in mesh issues and can read these scans and look for mesh issues-99.9% of surgeons can't. Anyways one surgeon saw on the same MRI that something didn't look right and his best guess was that there was an issue with the mesh. The second surgeon I sent my documents to who specializes in reading cat scans said he definitively saw that the mesh had bent or folded. I scheduled mesh removal with him (out of state and unfortunately out of pocket and traveled to Maryland ). He uses robotic assisted laparoscopic procedure. It was a 3 1/2 hour surgery and he said once in there it was way worse than he expected-the mesh had clued up into a ball and was rock hard. Because of my bad experience with mesh I asked for no more mesh to be implanted and he obliged. Originally before my first hernia repair I had a direct and indirect hernia. Fortunately, when he removed the mesh the there was no direct hernia-scar tissue had filled it in and no indirect hernia. There was some weakeness in the internal inguinal ring and he sutures the area up by bringing the internal oblique muscle to the illiopubic tract. He also noted slight weakeness in the femoral area. I am recovering and feeling better as each week passes. My questions are 1) if I should re-herniate in the future whether it is a femoral, direct or indirect hernia can the shouldice repair be suitable for me? I'm really hoping it is cause I don't want mesh ever again. 2) it is a femoral hernia how is that repaired with a pure tissue repair? I've heard there are really no muscles surrounding that area. 3) whether a direct or indirect hernia reoccurs does the shouldice technique cover/fix both areas in one surgery. Another words if an indirect hernia is repaired does the repair automatically repair the direct hernia space too and vice Versa? 4) my surgeon was able to remove 90% of the mesh but there is a little that had to be left on the illiac vein and the illiac artery (no nerves had to be cut-no neurectomies). Would the slivers if mesh left on these structures cause any issues for the pure tissue shouldice repair. Sorry for all the questions just trying to get my ducts in a row. Also there is a forum called hernia talk founded by a surgeon out in LA dr. Shirin Towfigh. There are tons of people out there looking for alternatives to mesh repairs. Most of the few doctors in there still promote mesh as the gold standard-it would be great if you joined and offered your expertise and point of view on the pure tissue repair and your statistics as many of these surgeons I believe are quoting theoretical statistics when it comes to non mesh repairs-like 10% recurrence rated and nerve pain issues. Anyways so glad to find you. There are many people suffering from mesh related issues and it is refreshing to find a surgeon who specializes in a alternative. I believe the pendulum will start to slowly swing back to pure tissue repairs as more and more mesh issues arise.
I am sorry for your experience. I would be happy to discuss your case over the phone. Call my office and schedule please: 631-638-0054. The short answer is that a pure tissue repair is still a viable option, and it would depend on the ability to develop tissue planes to sew to. Weight is very important when we talk about pure tissue repairs, too. Give me a call. Looking forward to speaking with you. — Samer Sbayi, MD
Hi, I had a hernia problem and that ended with surgery. Considering that I am satisfied with the service, professionalism and especially the care of recovery, I would like to continue recommendations. Quality repair is essence of good recovery and please educate yourself so you can prevent surgery or worsening of health. This article is perfect example and thanks for sharing your experience.
Hello Dr. Samir Are you familiar with Dr. Grischkan in Ohio? Do you perform the 4 layer repair? I am 63 years old 5’ 10” weight 150 lbs and have a reducible left sidedirect inigual hernia and want to take care of before hip replacement in June 2018. I have watched multiple utube videos of the Shouldice repair being done in the UK and the Shouldice center in Canada where you trained . I live in NH so Long Island is close . Would you be performing the procedure on me or would you be supervising. Thanks for your reply
I am not familiar with Dr. Grischkan. I replicate the complete repair here in Long Island, and I am the surgeon who does it. I will have other surgeons and residents in the room who will assist. I am training future residents to do the procedure. Kindly fill out the information packet at the bottom of my blog and contact my office to schedule some time to talk over the phone and answer all your questions. Thank you for reaching out to me. — Samer Sbayi, MD
Dear Dr. Sbayi, About 25 years ago I had an inguinal hernia repaired at Morristown Memorial Hospital in NJ using what was referred to as the Canadian method. I have recently been told by my doctor that I am in need of a revision. The doctor who performed the Canadian method recently retired. His replacement has recommended robotic surgery using mesh to secure the affected area. I am concerned that the original repair sufficiently altered my anatomy that a conventional mesh repair would not be advisable. Should I only seek to repair the recurrence of my hernia using the Shouldice method or can I consider a mesh approach as well? Thank you.
Dear Mr. Leszkowicz: Thank you for your question. You can do either way, mesh or mesh-free. If you would like to stick with mesh-free, I would be happy to evaluate you and help you decide if this would be feasible. Those trained and who practice the Shouldice repair are comfortable addressing the recurrences the same way. Mesh is also a possibility, but there is a fast-growing group of patients who don’t want mesh for several reasons. I am happy to discuss this further over the phone. You can call 631-638-0054 during business hours to make that happen. — Samer Sbayi, MD
3-6-18 Hi Dr. Sbayi I have a few questions: 1--I had a linguinal open hernia repair in Austin TX - in early July 2017 - with mesh - No vigorous exercise for about 5 months - Then the repair failed - and is now protruding again - I can still push it back in - and reduce pressure on it by eating smaller meals - The question is - Can you perform a "corrective repair" by removing the mesh and implementing your preferred method - The Shouldice Method ? 2--I am 69 - otherwise healthy and at ideal weight 5-7 and 135 lb - I have Medicare coverage - Do you accept Medicare ? (Typically 80% of the cost) Can you finance the remaining 20 percent ? 3--Would you be able to keep me overnight for a 24 hour recovery observation - while the anesthesia wears off ? And possibly another day for a follow-up visit - before I return home ?
Thanks for your email inquiry. Typically, my Shouldice surgeon colleagues and I prefer to wait 12 months to allow all the healing to take place and minimize any injury by going in too early. Yes, we accept most insurances, as demonstrated by others who have come from out of state. Keeping you for an extended recovery (i.e., <23 hrs) is also an option. Seeing you before you go back is also possible. Please provide me with your operative note from the surgeon who performed the repair you had done. Please call my office and speak to my hernia administrator, Lisbeth, at 631-638-0054 to discuss the insurance and schedule a phone call with me to discuss further. Hope this helps. — Samer Sbayi, MD
Greetings! I'm a 37 year old female with a small umbilical hernia. I am 6 months postpartum. There is no bulge or pain, and I only noticed the area was a bit tender when washing near my belly button. My local doc will repair without mesh, but only uses ethibond or prolene sutures, but I prefer stainless steel. I have no current plans to have more children, but want to keep the option open. My question would be, should I go ahead and repair, preferably traveling for Shouldice, or should I wait a year or 2 after we decide about having more children? Broad question, I know :) I wondered if the pregnancy would cause the hernia repair to fail and I'd have to have a second repair. Thank you in advance!!
Thank you for writing. Yours is a common question. If there is a confirmed hernia by yourself and your physician and you want to have it repaired, then timing is always important. The literature is scant as to what is the best way to approach this. My practice follows my experience at Shouldice Hospital in Toronto, Canada, which I use here at Stony Brook Medicine. Usually wait for total of one year after pregnancy, and you will be able to conceive two months after primary suture repair with stainless steel or proline. I have not seen any published results from Shouldice on this, and am hopeful that they will, as they likely have the largest database for this group of patients. If you wish to stay in the US, I am happy to discuss your concerns with you. Please feel free to contact me at 631-638-0054. Thanks again. — Samer Sbayi, MD
Hello Dr, I have a 1.5cm inguinal hernia on the left and .5cm on the right. I am 39 Male, 207 lbs and still trying to lose weight. I see a very small bulge and I can feel movement in that area when I shout at the kids and much more amplified when I sneeze or cough. It almost feels like a popping feeling it swishing. I have contacted the Shouldice Hospital and they have asked me to get to a target weight of 185 lbs. I am trying to see if there are alternatives to have it done in the US. The Shouldice Hospital has me scheduled for some time in October 2018. I fear I may not be able to hold out till then on both the weight and deterioration of the hernia. My real questions are (1) how many of these procedures do you get done in a year on the average? (2) did you complete the training at Shouldice because for some reason the Shouldice Hospital will not recommend any doctor in the United States (3) for strangulation to occur does will the bulge be so obvious? (4) what's then average rate of expansion for the inguinal hernia?
What you have for size is quite small, and would mean strangulation is (likely) low. For most the quoted rate is 1% or less. If it comes to that, it is a very dramatic event with swelling, pain, and redness ,and the bulge can’t reduce back. You would need to head to the nearest emergency department for evaluation. I have done over 700 since starting the practice of the Shouldice repair for inguinal hernias. I average at least 2 a week, which is nowhere near the volume I was doing at Shouldice Hospital. However, the practice is building. I am likely the only one in the US who is Shouldice-trained. From time to time, depending on who you speak with at Shouldice Hospital, they will mention that I am here. I still have good relations with them, and have visited in the recent past when I was back in Toronto. I don't think anyone knows what the average expansion is for any hernia, because it varies from one patient to another. I am happy to discuss this further at your convenience. Kindly contact 631-638-7920 to set up a phone interview. — Samer Sbayi, MD
Hello Dr Are you familiar with Dr Michael Reinhorn in Boston (bostonhernia.com) . He is offering the Shouldice Method and I am actually scheduled for the procedure on this Friday.
Dr. Reinhorn is a friend of mine. He did visit Shouldice Hospital, and I have seen him do the cases in Boston. He is self taught and has an excellent command of the anatomy of the groin. However, I am the only Shouldice-trained surgeon in the US, having done over 700 cases to date with an actively growing mesh-free hernia repair practice that sees many out-of-state patients. — Samer Sbayi, MD
Had an epigastric hernia 18 years ago repaired with mesh and have had tons of complications. i have a recurrence and the hernia is not bulging out with lots of pain and agony. have tons of problems from headaches, ringing ears, chest/abd pain, constipation, tightness in abd, lower extremity pain, memory issues since this has been in my body. is the shouldice method w/o mesh a way to remove the current and repair the problem? what is your current time line for upcoming surgery slots? if not soondo you have any west coast surgeons who practice shouldice method, you could recommend? thank you.
The pure tissue repair is strongly rooted in appropriate weight for the height. This is strongly related to its success and decreased recurrence rate. The tissue repair is well suited in these circumstances for primary and recurrent hernias. Mesh will be removed to facilitate a successful repair. I am happy to discuss this further, taking into account your full history. Please call my office at 631-638-0054 to set up a time we can talk to take a full look at your situation. I am currently booking into December. I am not aware of a Shouldice-trained surgeon in the USA. — Samer Sbayi, MD
I have read good things about the rapid recovery of patients treated with this method. It puzzles me that I read that the cremaster muscle is terminated for repair. This causes an inconvenience for the heating / cooling of the testes. I have also read that this resection is not mandatory and is not practiced by all surgeons. Do you have any news on this? Thank you.
The tranversalis repair that is integral to the Shouldice repair includes ligation ("terminiation") of the cremasteric fibers. This serves 2 purposes: it decreases recurrences of direct hernias, and allows for complete exposure of the floor of the inguinal canal to identify other defects, allowing proper opening of the floor and allowing for a proper transversalis repair. Data from the Shouldice hospital over75years now shows that exclusion of the cremasteric "termination" step allows for a higher recurrence rate. There are no reported untoward effects reported from the data from the Shouldice hospital. Any Shouldice repair as practiced at the shouldice hospitalalways includes this step. — Samer Sbayi, MD
Dr. Sbayi, I'm having a Shouldice repair for a right inguinal hernia tomorrow. I'm going through with the surgery but I've have one remaining question that no one seems to know the answer to. I have fibromyalgia (that's the diagnosis, I think it's generalized dystonia) and my muscles including my abdominal muscles spasm (aka trigger points) every morning when I wake up. I takes about 2 hours of direct pressure to relieve the muscles throughout my body before I can get out of bed. How do you think the muscle spasms will effect the repair? I currently have no pain from the hernia.
The spasms may exacerbate the postoperative pain, but will most likely subside once the postop pain resolves. — Samer Sbayi, MD

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