The Shouldice hernia repair technique is the best hernia repair technique in the right hands. Not all surgeons get the good results that the surgeons at the Shouldice Hospital achieve. The Shouldice Hospital has a solid recurrence rate of 1% and their incidence of significant chronic pain is less than 1%. Part of how they achieve these outstanding numbers is thru patient selection and use of mesh in 3% of patients. They will put off smokers and obese patients. This information was given to Dr. Petersen by a good friend of his, now deceased, Dr. Robert Bendavid, one of the founding presidents of the American Hernia Society and medical director of the Shouldice Hospital in Thorton, Canada. A large study independent of the Shouldice Hospital by the Cochran group in Australia found that their implementation of the Shouldice technique had a recurrence rate of 3.80%.
The Shouldice hernia repair technique is a tension free 4 layer repair using stainless steel suture and requires expert knowledge of the finer details of anatomy of the groin. You will meet your surgeon in the operating room. Their anesthesia protocol uses mild oral conscious sedation and local anesthetic. There is typically a three day hospital stay. This is where Dr. Petersen would go if he needed a hernia repair.
Critics of the Shouldice hernia technique by hernia mesh advocates sweep aside very important points and cherry pick data without acknowledging that they do so. See Reply to Dr Bendavid's Letter. The Shouldice Hospital does about 7,500 repairs a year. This experience cannot be dismissed as anecdotal. 4 layers of darned stainless steel suture is nothing like grams of knitted polypropylene mesh. Polypropylene material, even just suture, is a powerful irritant to our immune system. When knitted into grams of a mesh patch this effect is amplified many times. Stainless steel is one of the most benign materials we put into the human body. No one, with or without mesh, gets better results than the Shouldice Hospital by virtue of its technique and surgeons. Randomized controlled trials are not flawless. Bias can easily be introduces by study design and end point definitions. A recent publication of data from the Canadian Health Care system undeniably shows that the Shouldice Hospital gets much lower rate of recurrence than community mesh hernia surgeons. Less that 1% of Shouldice Hospital's patients develp significant chronic pain. 99% of hernia surgeons have no idea of what their individual hernia recurrence rate or incidence of significant post hernia repair is. When asked, they just blindly quote cherry picked studies which support their bias.
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