Mark T — a serious question
10/13/2022 at 9:37 pm #32756ChuckParticipant
i know you are a fan of shouldice….but do you believe they give their trainees enough experience? they have to participate in 50 operations before getting more involved….it seems pretty light. I am sorry if i have come off as insulting…i am just very frustrated with the state of hernia repain…it seems like there really is no safe repair. As i have said elsewhere…kang still seems like the best option…as his technique seems to be the least invasive but it troubles me that our freind watchful…is not impressed…watcfhul really digs deep…i wish i had dug as deep as he did….i fear i will never recover from my mesh butchery…even though all the plastic garbage was successfully removed. Dr B says he has never seen an indirect hernia return after mesh removal…but i want to be prepared next time….again please accept my apologies for being short tempered…this has been the worst time of my life…and i am still not sure i will survive it. I just had no idea a hernia surgery could be fatal…but if my pain doesnt resolve…it may well be for me.
10/14/2022 at 10:55 am #32757
I’m not sure I would characterize it as ‘light’ and particularly not when we consider how light it could otherwise be.
Technically, once someone is a licensed in general surgery, they could be repairing hernias…without something like the internal training described by Shouldice.
Every doctor goes to medical school for their MD, then can elect to do additional training for a specialization which must adhere the additional requirements of their jurisdiction’s governing body. This is true for those pursuing general surgery, emergency medicine, psychiatry, neurology, paediatrics, etc. In Ontario, that is typically overseen by the College of Physicians and Surgeons of Ontario (CPSO).
We see a lot of ‘general surgeons’ offering a variety of services that may include hernia repairs, but we have little idea what specific training they have in hernia repair beyond what was required for licensure in general surgery.
Shouldice hires such licensed general surgeons and puts them through their internal training program in the Shouldice repair. Alternately, they may hire an licensed physician who has not yet completed their surgical training (or who specialized in another domain), and puts them thorough a more comprehensive training program that meets the CPSO’s requirements for a general surgery specialization. They will still go through the internal training on the Shouldice repair.
Per their site, that internal training consists of assisting on at least 50 repairs before performing their own (regardless of their background)…and then they perform up to 100 more under direct supervision of a senior surgeon before being allowed to lead their own surgical team.
That 2nd part is likely intentionally flexible to account for differences in background, skill and comfort with the Shouldice repair, assessment by senior surgeons, etc. If someone came in as an experienced surgeon, then after teaching them the repair and after assisting on 50, they might only be supervised on a small number more before they are deemed competent to do their own…where as if someone is a ‘rookie’ surgeon, or has a steeping learning curve, then maybe that necessitates doing a bunch more after assisting on the 50.
I suppose that could still be thought of as ‘light’, regardless of what training other surgeons receive…but relatively speaking, I doubt that is the case. I would encourage people to ask other surgeons about their training background for comparison purposes. I suspect the Shouldice training model will hold up quite well in the vast majority of cases.
10/14/2022 at 11:12 am #32758
To be clear, I don’t see either the repair or the hospital as ‘flawless’ and above criticism. Nothing is certain or perfect.
I’m a fan of Shouldice because the repair has a long history of success, it avoids the use of mesh unless warranted, the training is specific and intensive, and the frequency/volume of repairs performed means that the skill/experience of the surgeons there is likely very difficult to match elsewhere.
In a world of uncertainty where we have incomplete/poor data, a wide variety of training and repair methods, etc., I just see less uncertainty with Shouldice vs. most other options. Hopefully, we will continue to see better studies and data on all of the options to reduce this uncertainty.
10/14/2022 at 4:03 pm #32760WatchfulParticipant
One of the things that I wonder about is how much we can extrapolate from the way things used to be at the Shouldice Hospital to the way things are today. They used to have some superb surgeons like Obney, Degani, Alexander, as well as Shouldice and Bendavid who were instrumental there. Also, they were very dedicated to their role there. It’s a different crew now, and many there do other surgeries at other places. That doesn’t mean it isn’t still one of the better places to go for hernia repair, but I’m just not sure that it’s quite like what it used to be.
11/07/2022 at 9:15 am #32928
Watchful, I agree that is it something worth wondering about.
On the one hand, a hallmark of Shouldice has been the regimented nature of its operation…all of their protocols seemed very standardized…consultation, admission, surgical training, repair, recovery, etc.
On the other hand, things tend not to ‘stay the same’ forever (at least not without concerted effort) and that could be true for Shouldice too.
I imagine the hospital is not immune from the modern reality of it being far more the norm for people to change jobs/employers a number of times throughout their professional career, even within the same discipline/role, compared to past generations or to dabble across more than one at the same time.
11/07/2022 at 8:19 am #32926saroParticipant
I would be curious to know from Mark if his happy successful surgery was performed in one session or was separated in two. As far as I know, today he is inclined to operate two together but before he preferred to distance them by a few months, I have no idea what is the prevailing strategy at Shouldice hospital
11/07/2022 at 9:00 am #32927
I did not have bilateral hernias…my hernias occurred many years apart (one side was repaired just over 30yrs ago, the other side almost 20yrs ago).
For bilateral hernias, my understanding is that Shouldice prefers to space the repairs apart by two days and simply extend the patient’s stay accordingly, but I can’t recall where I read that or if it is still the case. I don’t see info on their site, although a note in the outcome section of this 2016 study seems to reference that 2-day window:
“Hernia repair events occurring within 2 days of an earlier primary repair were not considered to indicate hernia recurrence, since bilateral repairs were often performed sequentially.”
11/08/2022 at 8:05 am #32938saroParticipant
thanks for your time. If I have more information I will be happy to contribute in my turn
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