The original way to repair a hernia was to close the defect in the abdominal wall by suturing it closed. The advantage of this repair is that it avoids the use of mesh. This repair was first described by Bassini and then modernized by EE shouldice in 1945. In traditional mesh repairs, using mesh has been associated with higher incidence of chronic pain as well as increased risk of infection. The posterior mesh placement in the advanced open pre-peritoneal repair does not cause the same degree of mesh pain as the traditional approaches.
Most studies suggest that hernia recurrence is higher in non mesh repairs. Most surgeons rely on this repair only for emergency situations where the risk of infection is high, and the use of mesh is too risky.
The Shouldice Hospital offers a non mesh repair to healthy patients. Their recurrence rate is quite low, due to the high volume of work, and strict patient selection process. I have personally visited the Shouldice Hospital and found it to be an impressive facility and a model for efficient hernia care.
Given some people's concerns about mesh, we now offer non mesh options for umbilical and inguinal hernia. I have observed the non mesh technique during my visit to Shouldice hospital in Toronto. While I perform this technique here in Boston, the surgeons at the Shouldice hospital perform over 500 surgeries every year and have more practice and experience than we do in that technique. For patients who are thin, this repair is a great non mesh alternative.