Looking for No Mesh Hernia Surgery near Boston Massachusetts?
The Shouldice repair is the Canadian, no mesh hernia surgery repair first described by Dr. E.E. Shouldice in the 1940’s. This repair uses a patients natural tissues to repair the weakness in the abdominal wall. Dr. Reinhorn was first asked by a patient to perform this technique. This particular patient wanted to avoid mesh, for her repair and did not want to travel outside of New England for her inguinal hernia surgery. Dr. Reinhorn observed this famous technique at the shouldice hospital and we offer it to patient who are good candidate for, and who want the Shouldice hernia surgery near Boston. We currently perform approximately 30 of these repairs each year due to increased demand for a no mesh hernia repair. While there is a lot of media attention about the complications of mesh hernia surgery, we offer both techniques in our practice.
Historical Background on the Shouldice Hernia Surgery
In 1889 Dr. Edoardo Bassini first published his success with a suture repair of inguinal hernia. In his original description he used interrupted sutures to bring together the Conjoin Tendon with the inguinal ligament. His published report demonstrated excellent results with only 10% recurrence rate after his repair. The Bassini repair became the gold standard inguinal hernia surgery for decades to come. It was a solid, no mesh hernia repair at a time before polypropylene mesh was routinely used.
In 1945, Dr. Earl Shouldice founded the Shouldice hospital, outside of Toronto. He recognized some of the shortfalls of the Bassini and improved on it with a four layered repair. He was meticulous in his study of hernia outcomes, specifically hernia recurrences. He even observed that cutting the posterior cremaster fibers, together with the genital branch of the genitofemoral nerve improved outcomes dramatically. With this maneuver, the floor of the inguinal canal ( transversalis fascia) is completely cleared, allowing for exploration of a femoral hernia ( by dividing the transversalis fascia). The remnant cremaster fiber is then used to wrap the cord, helping create a new internal ring. Dr. Shouldice observed that the recurrence rate after hernia surgery doubled from 2% to 4% when this move was eliminated from the procedure. As an American trained surgeon, I was never taught that move nor had ever seen it outside of the Shouldice hospital. It seems logical that this moves reduces and almost eliminates chronic nerve pain from that specific nerve, after the Shouldice hernia surgery.
Who is a good candidate for No Mesh Hernia Surgery near Boston Massachusetts?
While many patients are good candidates for a non mesh inguinal hernia repair, The Shouldice hospital has established guidelines of who is a good candidate for surgery and who is not. Clearly the single most important factor is abdominal girth. People with larger abdomens will create more pressure on the repair and increase the likelihood of the hernia coming back. Also the technical aspects of the repair may make it difficult or impossible to perform a Shouldice repair when someone’s abdomen is large. For most patients in the US, a posterior mesh repair (fast recovery – open pre-peritoneal or laparoscopic repair) provides for a lower recurrence and low incidence of chronic pain, making it the best choice.
There are many people who may have a contraindication for posterior mesh placement, may be at higher risk of chronic pain, or may generally be worried about the amount of foreign material in their body. For any number of reasons a non mesh hernia repair may be a great option for a particular patient. We have experience with multiple types of inguinal hernia surgery, including non mesh and mesh repairs, and are happy to provide a clinical opinion through a consultation in our office.
Dr. Reinhorn performs the non mesh Shouldice repair just outside of Boston, Massachusetts
Dr. Michael Reinhorn trained in Boston, in General surgery. Dr Reinhorn has been in practice since 2001, first in Concord MA, and now in Newton MA. He has performed over 3000 hernia operations on patients from all over New England and beyond. Most of his patients come from the Metropolitan Boston area, and many come from New Hampshire, Rhode Island and even Connecticut to have their hernia surgery performed by a surgeon who focused on inguinal and umbilical hernia. Since the demand for non mesh hernia surgery has risen in the Boston area, Dr. Reinhorn has taken the lead in offering the Shouldice repair.