Inguinal hernia is a common condition that has been treated for more than 3500 years, and the invention of the Bassini procedure in 1887 set the stage for the development of modern hernia surgery and the first real cure for inguinal hernia. The main steps of this procedure are still the basis of today’s open surgery.
Dr. Shouldice in Canada inherited and developed the essence of the Bassini procedure, creating the Shouldice repair and establishing one of the most prestigious hernia specialty hospitals in the world. After more than half a century of continuous improvement and experience, this procedure has achieved the lowest recurrence rate of the classic surgery and has become the international gold standard for inguinal hernia treatment.
(Dr. Shouldice and the Shouldice repair)
It is important to note that this top international hernia repair technique is a patchless repair that uses all of your own tissue and no patches (artificial hernia repair material). If a hernia is compared to a hole in a garment, a patch repair is a patch made of artificial material on top of the hole. Patchless repair, on the other hand, is a direct repair of the defect through a suturing technique, which obviously requires a much higher level of skill.
According to the experts at Shouldice Hospital, patchless repair is safe and effective and eliminates the risk of post-operative complications such as infection, chronic pain and fertility disorders associated with patches. Without the foreign body presence of the patch, the abdominal wall is more pliable and patients live more comfortably.
Unfortunately, the high technical requirements of this procedure may have hampered its widespread dissemination. Statistics show that less than 1% of Shouldice repairs are performed in China. In rural areas the less effective Bassini procedure is mostly used, while in urban tertiary hospitals patch repair is used almost exclusively.
(Shouldice Hospital, Canada)
To find out the real patchless repair, Dr. Qiang Zhang’s group traveled to Toronto, Canada to visit the world-renowned Shouldice Hospital.
Shouldice Hospital was founded in 1945 with a single operating room. The founder, Dr. Shouldice, led a nurse to perform two hernia surgeries per day. Today, the hospital performs 7,000 surgeries per year, with a cumulative total of more than 350,000 patients. 90% of the patients do not use patches, and the recurrence, infection and complication rates are less than 0.5%. The international leadership of this repair technique has to be recognized.
This shows that patchless repair can cure most primary inguinal hernias, not only safely and effectively, but indeed with fewer postoperative complications.
(Dr. Zhang Qiang Group’s chief expert in hernia surgery, Yuke Bao, shares his experience from China)
We shared the current status of inguinal hernia treatment in China with the core managers of the hospital. Everyone was concerned about the current status of overuse of patches. Mr. Urquhart, Chief Administrative Officer of the hospital, said that as patch usage increases, more and more patch-related complications are being identified, such as patch wrinkling, fracture, displacement, erosion, etc.
(Patch removed for complications after patch repair surgery)
Shouldice Hospital uses artificial patches for inguinal hernia repair in only 10% of patients. These patients have very weak self-tissue that cannot be used for repair. There are also patients who are recurrent cases after other repairs. They are the real candidates for patch repair.
Dr. Byrnes Shouldice is the son of the founder, Dr. Shouldice. He has followed in his father’s footsteps and has continued to refine the procedure. He gives us a detailed description of the patchless repair. Meticulous anatomy is the foundation of patchless repair. The inguinal tissue is separated into three layers according to the body’s own composition, the vital nerves are properly protected, and the hernia sac is fully exposed and properly treated.
(Surgical supply room staff demonstrating the special wire suture)
The special wire sutures are strong and compatible with the body, and they overlap and suture the tissues of the body in layers. Through the reduction incision and suturing technique, the tissues are aligned without excessive tension. The hernia repair seems to be simple, but every detail of the operation is done in the best way.
Through this exchange, we found that the philosophy of Shouldice Hospital coincides with that of Dr. Zhang Qiang’s group: always patient-centered, focusing on specialty diseases, paying attention to details, and making the best of surgery and service.
We believe that patchless repair is a safe and effective surgical procedure. Treatment of inguinal hernias is individualized and tailored to the patient. Most patients can be cured of their hernia using their own tissue.