Shouldice and indirect inguinal hernia

[DrBrown]

Dear Luke.
There are numerous methods for hernia repair and that should tell you that no one method is perfect, otherwise, all surgeons would use that method. When I fix a hernia I try to pick the type of repair that will give the best result. I often mix methods together.
Regards.
Bill Brown MD

[kaspa]

Pediatric surgeons are experts in non-mesh indirect hernia surgery. Often, they only ligate hernial sac, but sometimes they do a Marcy repair, if hole is too big. I once thought about hiring a pediatric surgeon. Their patients are mostly babies and children, but they can treat people until they’re 18, and these are physiologically and anatomically adults or near so. What do you think.

[Alephy]

I would also like to know…

[kaspa]

@DrBrown can you recommend some expert surgeon in ringplasty in North America and Europe?

[DrBrown]

@columb-if
Marcy with tightening of the internal ring (ringplasty).
Regards.
Bill Brown MD

[columb.if]

DrBrown
What kind of surgery do you sugest for small indirect hernia in adult? Marcy?

[DrBrown]

@alephy
A Shouldice will give a good result, but it is overkill for a small indirect hernia.
Regards.
Bill Brown MD

[kaspa]

It’s quite clear that Shouldice is used either for direct or indirect hernia or both.

[Luke]

Dr brown,

There seems to be a large amount controversy on using a shouldice for an indirect hernia repair. Most everyone that offers a shouldice suggest to use them on indirect hernias the same as direct hernias because they seem “bulletproof” when it comes to being the best pure tissue repair out there for the majority of all inguinal hernias. Then you have many of those doctors that say they perform shouldice repairs but only use a 2 layer repair still calling it a shouldice..like dr grischkan…it is confusing to the general public because you have shouldice 4 layer, shouldice 2 layer, modified shouldice, bassini, all interchangeable names with shouldice. Yet doctors say they are doing the shouldice. General public like myself has no clue what your getting. Can you perform the exact shouldice traditional method but only use 2 layers and not 4? Is the basic difference less tension and less reinforcement with the 2 layer? Could you do 3 layers and add a bit more reinforcement and tension than the 2 layer? Does it work like that?

Your suggestion of using the marcy does make logical sense…only fix what is broken. I’m confused as many surgeons who offer the shouldice do not offer a marcy repair. So if it is more simple to perform this repair on indirects and the outcome had greater success then why is there no other surgeons besides yourself offering this that I know of? Rather, most offer the shouldice, modified shouldice or desarda.

The marcy seems like it is too good to be true..very simple…close the inguinal ring and your fixed! But it doesn’t seem just closing the ring will not hold up long term or under as much physical activity stress as a shouldice repair. Obviously there is a genetic disorder to begin with and a few sutures in a faulty inguinal ring seems almost like puting a bandaid on a very large open wound so it is inevitably going to fail. It would be very uneasy and anxiety filled living daily being active knowing only a few sutures is holding everything together.

If reinforcement us needed on top of her marcy, do you offer a marcy with a 2-3 layer shouldice for the added reinforcement? Or do you prefer to he desarda for the reinforcement? The desarda does not have study’s supporting it’s effectiveness over the long term like the shouldice is tried and true. The desarda also seems to alter the human anatomy much more than the shouldice. Thoughts on this?

Please don’t think I am questioning you methods…I know you are a top reputable surgeon with great reason and success. These are only questions coming from a novice but I’d imagine others are scratching their heads like myself on these issues