The Difference Between Shouldice vs Tension-Free Hernia Repair

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An abdominal hernia is a protrusion of the organs within the abdomen through a weak area of the abdominal wall. A physician will assign a diagnostic name to the hernia, depending on the area of the abdomen it is located in. The locations in which a hernia will frequently arise is the inguinal and femoral areas.

Common Hernia Repair Methods

The first method of this type of repair is known as tension hernia repair. It involves cutting through the muscle, pushing back the bulge into the abdomen and using staples or stitches to pull the muscles layers tightly together and over the hole. This method can create a lot of pain and swelling in the area, and has the potential to stretch the muscle.

The Method of Tension-Free Hernia Repair

Tension-free repair is completed through the following procedure:

  1. A small incision is made into the abdominal wall under local anesthesia.
  2. The hernia bulge is then freed from the muscle.
  3. The contents of the hernia bulge is returned back to the abdomen through the hole made.
  4. A piece of mesh is placed inside and used to prevent the contents from again escaping through the abdominal wall.
  5. Another piece of mesh is included over the top part of the weak area of the abdominal wall, to reinforce it and promote healing.
  6. The mesh will connect together like “Velcro” to prevent anything entering or organs leaving through the defect.

Using this method, less pain and swelling is had compared to regular tension hernia repair. The person can return to normal daily activity within days, and there is a reduced recurrence rate compared to other methods.

Shouldice Repair

Shouldice repair was a technique created by Shouldice Hospital in Canada. This method does place tension on the muscle and is carried out in the following way:

  1. A cut is made into the muscle under anesthesia.
  2. The bulge is placed back into the abdomen.
  3. The muscles of the abdominal wall are attached together in two sections, layer by layer.
  4. The muscles will form a reinforced overlap over each other, and the layers can be secured using stainless steel wire.

Comparison of Shouldice Vs Tension-Free Hernia Repair

One of the best reasons for using shouldice versus tension-free repair is the reduced recovery time. The recovery time is lessened due to a reduced time in the healing process.However, not all hernias can be repaired by the shouldice technique. In some instances where there is scar tissue, the surgeon may opt to use a combination of the tension-free and shouldice methods, i.e. mesh is used to strengthen overlapping muscle.

One of advantages of the tension-free method is that it is reinforced by placing a mesh inside the abdomen and on the outside. This forms a patch that can improve a weak area. As a result of the tension-free technique causing a patch, there is also a reduced chance of the hernia recurring.

Another reason some doctors prefer to use the shouldice technique is that it is natural repair method. Tension-free repair does require a mesh to be put in place. This mesh will form scar tissue that will create a seal. However, if the person requires further surgery, the fibrous scar created can lead to more complications. This is especially true in men who have has reproductive or urinary surgery.

This brings us to another problem with the use of the mesh in tension-free repair. It is more likely to become infected as compared to shouldice repair.


Shouldice Hospital: Shouldice Hernia Repair

Journal of Minimal Access Surgery: Shouldice Repair