Shouldice Hospital Case Study Pdf

Shouldice hospital case study pdf

The operation of choice for repair of recurrence employed a preperitoneal approach using prosthetic mesh.

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Discussion This trial has not shown superiority of Shouldice repair over plication darn. The recurrence rate15 at 2 years was 4 per cent for Shouldice repair and 1. Only one of the 11 recurrences was attributable to the consultant surgeon, who had a year experience with the Shouldice operation, and it must be concluded shouldice hospital case study pdf the high failure rate of the operation was attributable to inexperience with this technique in the junior surgeons.

The results of such surgeons are almost identical to those achieved in a recently published trial of day-case inguinal hernia repair by junior surgeons".

The excellent results of the Shouldice operation have been reported by several hernia specialists. The applicability of this technique to surgeons in general or surgeons in training has never been tested in a prospective randomized shouldice hospital case study pdf. Intense debate has centred on whether a standardized approach imposing great precision in operative technique is more important than skilled surgeons applying a variety of At the Shouldice clinic, new staff surgeons receive close supervision for the first 50 herniorrhaphies and d o not operate independently until they have repaired inguinal hernias.

The second assessment of operative technique is made after the first hernias, and only after this assessment is the surgeon considered a fully fledged independent operator. The present supervision of only six herniorrhaphies was therefore clearly inadequate. In a recent letter to this Journal from the San Josef Hospital, Vienna, Kux and FuchsjagerZo indicated that they were undertaking a prospective randomized trial comparing Bassini and Shouldice repairs. Results of this trial have not yet been reported; patient entry was halted in No other clinical trial has prospectively compared Shouldice repair with other types of herniorrhaphy carried out by non-specialist surgeons. Six recurrences caused by posterior wall failure occurred within 6 months of Shouldice repair.

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This finding implicates technical problems in reconstructing the completely divided floor of the inguinal canal. Inadequate repair of the posterior wall by plication darn appears to result in a more gradual weakening of the posterior wall, which becomes clinically apparent at a later stage.

In the setting of a busy general surgical unit where junior surgeons received supervision for six Shouldice repairs before independent practice, recurrence was not diminished by utilizing this repair compared with plication darn. Examination of the reasons for technical failure of Shouldice repair suggests that the technical feature that needs to be most carefully taught is the layered reconstruction of the posterior inguinal wall.

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One consultant surgeon and 14 junior surgeons performed the operations with an even distribution between Shouldice repair and plication darn Table 3. No junior surgeon was allowed to participate in the study until six consultantsupervised Shouldice operations had been performed. Subsequently, when a junior surgeon was supervised by a more senior surgeon, the operation was attributed to the senior surgeon.

Follow-up to 24 months was achieved in 70 per cent of patients Table 4. There was no significant difference in recurrence rate between the two groups at any time during follow-up.

All recurrences were confirmed by the consultant who carried out the subsequent repair.]

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