Shouldice procedure with Dr. Sbayi (or Shouldice Hospital or Dr. Yunis)?

Hernia Discussion Forums Hernia Discussion Shouldice procedure with Dr. Sbayi (or Shouldice Hospital or Dr. Yunis)?

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    • #30671

      Has anyone here had a Shouldice repair with Dr. Sbayi? How did it go? I’m considering him, or the Shouldice Hospital, or Dr. Yunis.

      With the Shouldice Hospital, some aspects aren’t appealing:
      (*) No ability to choose the surgeon. You could get one of their best, or one of their worst, or even a trainee under supervision.
      (*) Their reviews are mostly good, but there are quite a few bad ones as well. Seems like a bit of a crapshoot.
      (*) They cut the cremaster muscle and its nerve.
      (*) Staying there for 3-4 days seems like overkill and not appealing during COVID when visitors aren’t allowed, and a mask has to be worn at all times, etc.
      (*) Not sure why they use staples to close the incision.
      (*) Follow-up is likely more difficult for people in the US if any issues develop.

      Dr. Sbayi seems like a good alternative, but I can’t find many patient reports of experience with him. He also cuts the cremaster muscle and its nerve.

      Dr. Yunis has many good reviews. Some considerations with him:
      (*) He doesn’t cut the cremaster/nerve. Not sure if that’s good, bad, or neither. I’d rather not have it cut unless it really makes a meaningful difference in recurrence or something else.
      (*) He uses Prolene rather than steel, which I can’t really assess one way or the other, although I think there’s a higher chance of inflammation or allergic reaction with Prolene than steel.
      (*) He’s done quite a few such procedures (a few hundred I think), but he mostly does mesh. Also does Desarda.

    • #30676
      William Bryant

      Nothing scientific, but would have thought prolene was less likely to cause inflammation or adverse reaction. Have I got that wrong?

      Again, not scientific but don’t see advantage in cutting cremaster or nerves etc.

    • #30678

      Prolene mesh and sutures can cause reactions. Stainless steel supposedly less so, but not sure by how much (allergies to metals do exist). Regardless, my understanding is that those adverse reactions are rare in both cases, so I don’t think I have a strong preference for one versus the other.

      The advantage in cutting the cremaster muscle and genital nerve branch is somewhat lower hernia recurrence rates according to the Shouldice Hospital.

    • #30679
      William Bryant

      Think I read it’s to stop testicle going up into channel and undoing repair. Something like that.

      But seems a bit drastic. Maybe it helps keep their recurrence rate down? That seems to be important.

    • #30680

      My understanding is that cutting the cremaster reduces the bulk of the spermatic cord, and this enables a tighter repair. Also, there are benefits in better visualization and access for the area. I read that they also use the end of it to shape a new inguinal ring.

      It is a somewhat controversial part of the procedure, and not all surgeons do it, but it has been shown to reduce hernia recurrence in some studies. Not sure what all the downsides are – it does indeed seem a bit drastic to cut this muscle and nerve.

      If even the experts disagree on this, not sure what hope there is for us patients to sort it out.

    • #30681
      William Bryant

      Ah yes it does make working the area easier visually.

      Is there any (adverse) effect to mans sexual capabilities… Some surgeons say none, some patients (sadly) say yes.

      Also say they’re not just motor but also sensory – or vice versa!

      • #30682

        It is both motor and sensory. The motor part is for the cremaster and dartos muscles. The sensory part is for some areas of the skin of the scrotum. It shouldn’t affect sexual function. Also, scrotal sensation supposedly comes back eventually.

    • #30691
      William Bryant

      Thanks Watchful… Not sure, shouldn’t is as categoric as I’d like. I’m a bit worried about this as most surgeons seem to gloss over what they actually do with fancy terms like transect or transpose. Not sure what either mean!?

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