Shouldice vs. Desarda

[Alephy]

I am thinking a surgeon with the skills and approach as described above doesn’t probably exist in Europe. Even the pure tissue surgeons here just offer one technique mostly….

[Alephy]

Thanks for the post! Can anyone on advice on a surgeon in Europe or even Switzerland with these skills as in @drbrown answer?

[DrBrown]

Each hernia repair needs to be tailored to the patient’s anatomy and needs. Your surgeon should have all these various methods available and then choose which will give the best result for your situation. For example, in a young athlete with an indirect inguinal hernia, the Marcy hernia repair with ringplasty yields excellent results with minimal dissection and minimal postoperative pain.

For direct inguinal hernias, the Bassini, the Shouldice, and the Desarda are all excellent choices. The Bassini repair is a great technique, especially if the floor of the inguinal canal is just weak and not fully torn. The traversalis fascia is sewn to the shelf of the inguinal ligament. The Desarda also provides excellent results. There is very little tension on the repair. But the Desarda repair does require a strong external oblique aponeurosis to serve as a patch. Therefore, it is not a good option if the external oblique aponeurosis is torn or weak. Shouldice is an excellent operation. There little tension on the repair. The four-layer repair is solid. But it does rely on an intact inguinal ligament. Thus, there will be times when the Shouldice may not be possible.

The McVay repair involves the use of Cooper’s ligament instead of the inguinal ligament to repair the inguinal floor. It is an especially useful technique in situations in which the inguinal ligament is damaged, or there is an associated femoral hernia. The McVay hernia repair does have tension on the repair and may require more recovery time.

Your surgeon should know all of these techniques for hernia repair. And he or she will often find that a hybrid operation using the best ideas from each method are needed to achieve the best result.
Regards
Bill Brown MD

[Alephy]

More than the difference between the two, I would eventually like to see a list of recommended/possible procedures based on the hernia type (e.g. inguinal direct vs indirect), age, fitness level, preexisting conditions etc. The hernia type should be the first guiding principle I guess (I am no doctor, so this is possibly bogus)…whenever I asked Doctors how things would change if it was direct/indirect the answer was always, no change it is the same, doesn’t matter…

[watchful waiting]

Much thanks to Bill Brown, M.D. for the comprehensive look at the various techniques. When I sold to orthopedic surgeons I learned that the skill of the surgeon is the most important factor in determining a good outcome. Can you kindly advise where you are located, any contact info and if you are taking new patients? Thanks.