Shouldice Repair, Dr. Sbayi, Stony Brook NY
Tagged: Shouldice USA Sbayi
07/24/2022 at 3:21 pm #31837Mr. SeaParticipant
Hernia surgery is real surgery and therefore as a patient there some decisions that have to be made.
The two most important decisions for me were; who is going to do my surgery and secondly did I want the surgeon to use mesh or a non-mesh approach.
I would like to thank Dr. Towfigh for the work she has put into this valuable website and I would also like to thank all the commenters who have shared their thoughts. I read through a lot of the discussions here and benefited from reading them. I thought it only fair that I return the favor as the Shouldice vs. Mesh approach is a frequent topic and I just underwent surgery to repair an inguinal hernia. Dr. Sbayi performed the procedure using the Shouldice technique and the surgery was performed as an outpatient procedure at Stony Brook Hospital in Long Island New York. I am now four weeks post-op and very pleased with the outcome so far.
I live in the United States and I spoke with a number of general surgeons I am friendly with who recommended I just go ahead and repair my hernia with the common mesh techniques and quit worrying about it.
The consensus of much of the medical community is that the non-mesh methods have a considerably higher recurrence rate when compared to the mesh methods. It looks like they may be correct.
Some studies report non-mesh recurrence rates of 20% while other reputable sources report recurrence rates as high as 30% or 40%. With reports of non-mesh recurrence rates ranging from 20% to 40% you could hardly fault surgeons from staying away from non-mesh repairs.
On the other hand, you have the Shouldice Hospital reporting a 1% rate of recurrence with their non-mesh technique. Are they lying? Who is right?
After extensive reading of the clinical literature, it looks like both sides are right. The Shouldice Technique has been practiced now for over 70 years. Dr. Shouldice and the surgeons who have picked up the torch from Dr. Shouldice upon his passing in 1965, place significant emphasis on methodically performing the technique exactly in the manner Dr. Shouldice taught. The Shouldice technique was an improvement on earlier techniques and during his career Dr. Shouldice became very clear on what works and what does not work. As taught by Dr. Shouldice, the technique must be methodically followed step by step with any variations, even minor, kept to a minimum or avoided altogether.
As it turns out it appears to me by comparing the clinical literature, if the surgery is performed by a Shouldice trained surgeon you can expect an approximate 1% recurrence rate. If the surgery is performed by a non-Shouldice trained surgeon, even if it is an excellent surgeon overall who may have read about the Shouldice surgical technique and is giving it his/her best shot, the recurrence rate is by comparison very high. There are other non-mesh techniques out there but most are considered less successful on a large scale in comparison to the Shouldice method which is the gold standard of non-mesh repairs.
A patient is usually best served by receiving the care that falls into a surgeon’s comfort zone or core competency if you will. Ideally you want to receive the benefits of their training by allowing them to perform what they do best; Shouldice, non-Shouldice, or mesh.
In my case I decided that I wanted the proper Shouldice method performed by a Shouldice trained surgeon with plenty of practice.
This looked easy enough, but looks can be deceiving.
I called the Shouldice Hospital in Canada and optimistically started to scheduling my surgery. Much to my disappointment I was stopped in my tracks when they asked if I was double vaxxed and boosted. I am neither single vaxxed nor boosted and Canada, not Shouldice, requires two shots and a boost or two to enter the country.
I called back the following day and asked if they knew of any former Shouldice Hospital surgeons who had moved to the States after being properly trained and experienced in the Shouldice method. Very nicely the operator said yes and gave me the name and number of Dr. Samer Sbayi at Stony Brook University Hospital in Long Island New York.
The Shouldice Hospital and several journal articles place significant emphasis on the routine performance of the Shouldice technique as a requirement to being able to perform the procedure and maintain the very high rate of successful outcomes. During my discussions with Dr. Sbayi and his office they indicated he currently performs over 100 Shouldice cases a year which keeps his skills current.
Other than being apprehensive about the post-operative experience, setting up the surgery was not difficult. I spoke to Theresa who works with Stony Brook & Dr Sbayi’s office and she was more than helpful and quick to answer questions. We scheduled a telephone/video appointment with Dr. Sbayi which went smoothly. Dr. Sbayi answered my questions and confirmed I was a likely candidate for the Shouldice Technique. I then scheduled the surgery and confirmed my insurance coverage through Theresa. My pre-op surgical clearance was performed by my local general practitioner. Appointments to meet with Dr. Sbayi in-person and the hospital anesthesia staff were scheduled for the day before my surgery.
Theresa directed me to a hotel which is adjacent to the Stony Brook campus and close to the outpatient surgery center. We flew into the Long Island MacArthur Airport in Islip New York the day before my appointments and rented a car. I highly recommend renting a car for your pre-op time in town. We drove to Port Jefferson, locally referred to as “Port Jeff” which is a lovely little waterfront town to have a meal and walk along the waterfront. The following day we used the car to drive to Dr. Sbayi’s office and to drive over to the hospital to meet with the anesthesia staff for further clearance and discussions.
The following morning, I reported to the surgery center at 6:00 AM and checked in. I had several brief and friendly interviews with the staff as they competently checked and double checked everything. At about 7:30 AM I walked into the OR with a nurse and introduced myself to the OR team then laid down on the OR table and promptly “fell” sleep.
I awoke approximately one hour later in the recovery room to the good news that all went well. I felt no serious pain as the meds administered by the staff were doing their job. As soon as I was clear and comfortable, they let me check out of the hospital and by 11:00 AM I was back in my hotel room.
It was here that the anticipated nightmare of pain never occurred. The stories of other hernia patients (non-Shouldice mostly if that matters) painted a picture of several days of absolutely miserable almost unbearable pain with difficulty just getting up or using the rest room. I was not looking forward to the first several days of pain. My surgery was Friday morning and my homebound return flight was Monday afternoon. I had been concerned that my flight was going to be too soon after my surgery. Would I be able to fly with this painful abdominal wound was my concern?
Well reality was far better than I anticipated. I do not want to sugar coat it or pretend I am in a hurry to do it again but it was not too bad. Yes, it was surgery which is never fun, but I needed the surgery and the post-operative pain in my case was clearly manageable. During my post-op stay at the hotel I was able, per doctor’s orders, to walk around the hotel, go up and down stairs for exercise, watch some TV, and have dinner in the hotel restaurant.
Dr. Sbayi prescribed prescription strength Tylenol to be taken every six hours and prescription strength Advil to be taken in between, so every three hours I was taking a dose of one of these two pain meds. He also prescribed a small amount of Oxycodone to be taken as needed. I took one Oxy the first day and one the second day but I promptly realized I did not need them at all as the Tylenol and Advil kept the pain to very acceptable levels. Having the Oxycodone available gave me the security that if the pain was anything like people described I would have something to knock it down with but that proved unnecessary and I did not take another Oxycodone.
Our flight home was uneventful and the pain was never more than the basic meds could cover. I don’t want to do it again and I am only a case study of one, but if you have a post-operative experience like mine, you will be just fine.
Bottom line is at this short post-op timeline of four weeks, I am a fan of the Shouldice Hernia Repair and grateful to Dr. Sbayi, his training, and availability to perform the procedure. I hope I still feel that way twenty years from now and at this stage, that appears likely.
I do not want to imply mesh is bad. Mesh is a tool and an option that has its place in medicine but I did not want it. It does concern me when mesh is the only tool in a surgeon’s toolbox of core competency.
The Shouldice Hospital says they use mesh in somewhere around 5% of their cases if I recall correctly and Dr. Sbayi says he will also use mesh when called for.
Based on my limited experience, if you live in the States and need a hernia repair, I would suggest at least considering the Shouldice Technique. Then consider going to see Dr. Sbayi. I believe he is the only one in the States with a significant history with the Shouldice Hospital.
I have seen some posts about some excellent work a surgeon in South Korea is performing but if my experience is representative of what most patients experience, there is certainly no need to travel farther than New York.
I will post the contact info for Theresa at Stony Brook Hospital below. She answered all my questions and put me in touch with Dr. Sbayi.
Best of luck to all of you,
Contact info for:
Dept of Surgery, Stony Brook Medicine
08/15/2022 at 3:07 pm #32210Good intentionsParticipant
The link in Dr. Towfigh’s post does not bring up the whole thread.
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