This makes anyones numbers on hernia repair difficult to interpret, but the Shouldices number in particular should be viewed with a grain of salt. 2016 Feb;59(1): 19-25. To you doctors and surgeons; I do wonder if you feel any guilt for installing these meshs in your otherwise healthy patients I certainly couldnt do it from what I now know. Which method is the best option considering I want to get pregnant? Pure tissue technique, according to yourself and other general surgeons, has the risk of recurrence. I wish all the best to you! 2021 Apr 1;51(4):67-69. doi: 10.1097/01.NURSE.0000736968.01359.e0. They stick to what they know but when they need to be different for the better of their patient they dont know how to and rather than referring their patient to one that would be better for the patient. We were guests at the Shouldice Hospital last year. This is so helpful! I sympathize with you and your husband. Stop smoking for a least 2 weeks before your surgery. Large ventral/incisional hernia repair or complex abdominal wall reconstruction- different story. I have had this happen once. Physicians (surgeons) do what is best for themselves and the patient when making the decision whether or not to operate. Straight truth from the USA here folks. After 3 months, 2 months with some insurance companies it is no longer considered a pre-existing condition. Train operators. Oddly general surgeons have recommended neurectomy though the pain clinic doctors I saw were highly against this type of procedure. MeSH terms Adolescent Adult Age Factors So why would you do so for an inguinal hernia repair, a surgery that is far from simple and fraught with potential serious complications, mesh or no mesh. This is critical, because one of the patients greatest fears is an obdurate, shrugging surgeon suggesting post op that there are no guarantees in life and this is all in your head. My first week after surgery at Shouldice wasnt too bad. He never admitted to any pain and shortly before my son was born developed an I augurales hernia. I can still thankfully work but havent been able to exercise without being in major groin pain. So even when you think you have done your homework on the surgeon get another opinion. Not true.If they Identify an Hernia with no bump, they will ask for repair it. So yes, that is you, the taxpayer, footing the bill for unnecessary care being provided by a private company. The clinic sits on luxurious grounds and offers one thing and one thing only. As usual the media has overrepresented the risks. Best of luck. The first consultation is walk in which for me meant a 3 hour wait in a run down old estate living room. No referral is required. I would not that in Canada most people are referred to a surgeon they do not really know for most procedures. 3 weeks after surgery, I was starting to return to running, but still avoided lifting anything heavy. Unlike most hospitals, delicious meals are prepared fresh in our dining room daily, providing the healthy nutrition you need to promote healing. Studies show that half of all recurrent hernias develop many years after the original repair. Authors Anna Bradshaw 1 , Sarah Raphaelson. The Shouldice Hospital in Thornhill, Ont., is world renowned for its treatment of hernias. My biggest concern is chronic pain and it seems there is a lack of research reporting on chronic pain and pregnancy. Surgeons need to do emergency work or perforated appendicitis, gangrenous gallbladders, and blocked bowels (sometimes stuck in hernias) would not be dealt with, and patients would die. If I was doing the Shouldice repair with no mesh and keeping my patients in hospital for 5 days after hernia surgery, I would probably have my competence questioned, and with good reason. Our specially trained surgical teams perform over 7, 000 hernia repairs every year, with an unparalleled track record . That is why Im looking at surgery but here in the US my surgeon says mesh is the only option and that he will be using a medium (as opposed to ultra light) mesh with plenty of overlap to repair the hernia. The limited walk-in spaces are available on a first-come, first-served basis. The reason my wife and I offer the Shouldice op in Kent UkK is the very high incidence of chronic pain after open mesh repair. I agree with everything that you say. One might wonder why you could not find a surgeon in New York willing to do a repair without mesh- are all of these surgeons incompetent, immoral, or both? Reilly's, a disused bar, was barricaded up by the rebels, and it . 4. shouldice offers a 4 day vacation. Also, you didnt say if your two hernias were repaired laproscopically or open. 2. shouldice offers low cost. (As does everyone). Shouldice - The best no mesh hernia repair for inguinal hernia. It may be in part an attempt to keep a surgeon ratings list from being established, as patients are not allowed to pick a surgeon. They actually recommended that my other hernia not get operated on as it was too small to be fixed (which was really impressive that they gave the correct advice, watch and wait). Just returned from Shouldice. One year before he developed necrotizing fasciitis, extending from the right knee to the right thoracic wall resulted . (2) do you know of the desarda method of no mesh surgery? Its not hard to understand whats happening here. While I do like my patients to rest after surgery, they dont need to do it in a hospital setting. Walk-in spaces will be provided for a limited number of patients every Monday to Friday. Maybe a freedom of information request needs to be filed so accurate comparisons can be made. One thing Ill add, is a problem with the Shouldice technique is that its complicated for a surgeon who is not very experienced with it. They do the surgery anyways. Discover the Shouldice Experience We offer a complete and holistic recovery program that promotes healing and a rapid return to normal activities. I cannot recall a patient ever having been in hospital for 5 days after elective hernia repair. Also, I find there is a lack of information on hernias in fertile women and how to treat. When needed, a hernia weight loss diet is individualized for each . As anybody else, my concern is long term pain or discomfort and recurrence. Do your homework and make an informed decisiongood luck. It was recently taken over by a private company and is no longer in the hands of the original Shouldice family. Lot of disparity in the anecdotal evidence (my understanding has been that in at least once instance a patient was offered a days long recovery at Shouldice vs weeks long at a hospital, and that has been constant with my knowledge of their reputation in general). Registration will begin at 8:00AM and will close once we have reached the maximum number of appointments available that day. . This makes any numbers they publish about their recurrence rates completely out of touch with the reality of what myself and other general surgeons are dealing with in our practices. It seems like a roll of the dice. Given the heightened concerns with the transmissibility of COVID-19 and the pressures on our Emergency Departments, we ask that you consider your healthcare options before visiting the hospital for non-emergency concerns. The food was good. My father needs a hernia operation. I have constant pain of some kind from stabbing to just dull along with foreign body sensation. I went into general surgery because its well, general. I agree with Toronto that it is hard to find any real data on the Shouldice clinic. Does it annoy surgeons that many many *easy* abortions are done in clinics rather than hospitals? Tickets cost $4 and the journey takes 38 min. and then he has the audacity to tell me that I cant feel the mesh and that the pain is also in my head. Shouldice, a brilliant surgeon who revolutionized inguinal hernia repair by developing a dependable, no mesh technique back in 1945. I did that search, and Im not sure if I saw exactly what you saw, but yes even though Shouldice method (performed at the Shouldice hospital specifically) has a very low recurrence rate, certainly mesh will have the lowest recurrence rate. This clinic needs to keep people in hospital to make money. Its not much. I just left Shouldice hospital after a hernia repair. 6 Strategies for Managing Customer Wait Times 1. In Australia, the introduction of private healthcare has resulted in exactly what has happened here, albeit on a much larger scale. My hernias were small (umbilical and femoral) and related to pregnancies and not a previous incision. ParkingOn-site parking is available for hospital and clinic patients for a flat-rate maximum of $15 per day ($50 for the duration of an inpatient stay). . in sum, shouldiced uses high value, low cost strategy. Critiques are always welcome because it can make people think out of the box. I agree. If this is an arguement that many surgeons feel should be addressed then of course I would be open to hearing the arguments for it but I believe our health care system should have a structure thats based on requirements necessary for delivering good outcomes for patients at the best cost. This is so important, but our electronic medical records do not allow that to happen at this point in time. I went for a long walk after the surgery. C. Shouldice Hospital is returning to Vancouver to conduct examinations in March 2023. Of course when people go there, they are concerning about the bumps that they have so, and they do not take hernias that are not obviously visible right at the time of surgery itself. She suggested that the nerve fibre regrowth in the skin layers around the surgical site may be causing the sensitivity. This was a very informative post. What happened to good doctors? Shouldice is the gold standard of no-mesh hernia repair. No public hospital in Ontario would be keeping groin hernia repair patients in hospital overnight without some underlying compelling reason. To me, mesh is the risk here, not hernia recurrence with pure tissue. I honestly cannot recall the last time I admitted a patient the night before surgery, except when I was a clinical clerk, and that is going back a long time now. Don, The benefits of mesh far outweigh the risks for the vast majority of adult hernia patients. The grounds were beautiful and interior spaces quite nice. I was told my mesh was new but found that it hasnt changed much since 2009 when Bard first came out with this polypropylene mesh. Our current career opportunities are outlined below. And yes chronic pain is an issue which needs to be better studied in terms of techniques to prevent it and treatments. I hike a lot, mtn bike, lift >100# items, etc. The nursing staff was a mixed bag, as would be expected anywhere. Affiliation 1 Anna Bradshaw is an FNP student at . .One year after this major Shouldice surgery in MAJOR pain EVERY day and night I NOW look like a fucking mutant due to their amazing technique over there at Shouldice and to no email at least 15 trips back there and numerous emergency visits and NO family doctor. In the USA most Drs wont even do a simple hernia repair without mesh even if youre ideal for a non mesh surgery. We have provided a list below of accommodations and we have arranged special rates at some of these. Visitors will not be permitted in the patient rooms. Sorry to hear that John. I then met the doctor who told me to lose 25 pounds and return. I have seen these numbers elsewhere also. A lot of nerve damage occurred to my femoral nerve, and the mesh they have inserted is extremely painful. Femoral hernias are tricky sometimes whether mesh is used or not. Now as a confession of a conflict of interest here, I am a general surgeon who does lots ofhernia repairs at a hospital about an hours drive from the Shouldice. The office staff takes care of business very nicely, very personable, walking you through every step of the way. Is it because they make lots of money off the patients and the taxpayers? My husband got discouraged and gained even more weight. Create a free website or blog at WordPress.com. In fact, that is the only operation it performs, and it performs a great many of them. The other day I split a bush cord of firewood and my shoulder was sore but not my groin. shouldice clinic wait times. It seems you did your research thoroughly and are maybe one of the unfortunate ones. Five days after surgery Im still in quite a bit of pain, and Im finding Tylenol to still be a must. On another topic, but those expenditures offer a glimpse as to why medical bills are the primary reason for personal bankruptcy in the USA. Pick a curve, any curve (say, the red one). So you are absolutely right, there should be requirements for all surgeons and health care providers to follow evidence based medicine and try and make patients better. They have permanent audit staff and know their outcome details. A: The Shouldice repair is named after Dr. Edward Earle Shouldice (1890-1965), the Canadian surgeon who invented the technique in the 1940s. So Im going to outline some of my problems with the Shouldice clinic, which is held up around the world as a great Canadian healthcare success story. The limited walk-in spaces are available on a first-come, first-served basis. So there isnt a problem with mesh? In this respect, mesh in the future could still have a place but as a last resort rather than the first thing the surgeon grabs! In addition, in my case Im 41 and 168 lbs. 00%| | Expected . And If I wasnt beginning to suffer the effects of cabin fever, and didnt have a life to get back to, I was almost sorry to leave to return to the UK. It has been repairing hernias for decades. It was then allowed special licence by the Ministry of Health to continue operating. A tearing feeling (like being stabbed) from bowel movements is prevalent; on the positive side, I had my first pain free sneeze this morning. I had little to no pain 4 days after the surgery, and other than a small scar, my groin has been perfect. I am scheduled to have a right side repair done at Shouldice next week. Inguinal surgery 4 days ago at Shouldice performed by surgeon with 10,000+ hernia surgeries performed. I had should ice give me the paperwork anyway and submitted it 2 times to my insurance and went thru an appeals process Finally I did get about a 60 percent payment back Think they got tired of me.. Haha. That is an important distinction. The worst things said seem to be about the dcor of the hospital, the way the nurses and doctors treat you/pillows too small/beds like rubber etc. I went for consultation at Shouldice in October 2013 for consultation regarding an umbilical hernia repair. He worked at Shouldice for about a year and did several hundred Shouldice repairs. Many of these services are provided free to our patients. Three delicious meals every day, plus an evening snack, An exercise program specifically designed to speed the recovery of hernia patients, Professional advice for a healthy recovery, Access to on-site massage therapy (extra charges apply). If hernia repair is right for you, well set a hospital admission date that is convenient for your schedule. I wonder what steps should I take once Im ready to see a new surgeon in Ontario? We have provided this list as a courtesy to our patients and their guests. If someone has a hernia surgery at one hospital and then develops a complication they could easily end up at the emergency department of some other hospital having the repair done by a completely different surgeon. It is almost impossible for a hernia to recur through a piece of mesh. The surgeon recommended TEP and from research that seemed to be the most likely not to cause chronic pain and based on the surgeons bio and reviews he seemed to specialize in laparoscopic. Im sure there are anomalies in either system, but like I said, Im rather surprised to hear that a place that is known for its speed (even among layfolk that have no business following the performance of hernia clinics) is being depicted as slower than public held alternatives. There is absolutely no risk involved, just a requirement for the patient to wear an orthosis. I know 2 other people who have gone up for repair both of which are now well over 30 years on the repair without issue also.. Take care safe travels. Another confession, I alsomake money doing hernia repairs, but I dont make nearly as much as the Shouldice does off their patients. Most of the arguments against Shouldice here seem to have very little to do with the actual technique, pain afterwards or recurrence (irritation, I thought, at the Southfork-like set-up and possibly also at their very existence fuelling endless questions like mine: is mesh a problem or isnt it? From studies (which are few and far between), they both apparently have the same amount of chronic pain sufferers. I do have recurrences, about 1 per year but I find since I have warned the patients about this they are usually pretty accepting of it and happy to come back to me for another repair. I tell women who may get pregnant after a repair that there is a higher risk of recurrence of the hernia because of the stretching of the abdominal wall with pregnancy. We know that asking patients about their satisfaction with their care has nothing to do with the quality of care provided. And it IS true that mesh design has improved not just materials, lighter, thinner, for instance Titanium coatings to reduce foreign body reactions, so problems 2 or 3 years ago may be referring to old technology. Im about 2hrs from Shouldice. Shouldice, like you said, does not do that kind of thing. Talking about media ( from the article you posted here ) Well that was 2 years ago, he did lose 45 lbs and the doctor still refused to do the operation siting that he had no place to put what was in his testicle area! I dont think it has been around that long. Thanks for your blog. Leave jewellery and other valuables at home. Complications after a mesh surgery can drive the cost of a simple hernia repair into the hundreds of thousands of dollars. The doctor in Quebec told him to lose 30lbs and he did but while waiting his hernia became even larger. Informed consent is crucial. In fact, the most over investigated, over treated patients are likely to think they have great care, when the opposite is the truth. There are definitely many who travel to Shouldice from the USA, where last I heard it runs somewhere around $6500 paid out of pocket for an inguinal hernia repair and the multiple night stay in a facility that supposedly feels collegiate. Its one of the great things about my job. We never rush you through surgery and send you home the same day; thats very stressful for both patients and their families. There is a sunlit caf for reading and relaxation and a cheerful common room, where patients often gather for a friendly game of cards. Update been 8 months out and little to no change in the pain and other complications. Whether that fear of mesh is warranted, I do not know. A friend of mine had the mesh technique and it resulted in a tumour growth that was quite complicated to resolve. The place is charming. ( I know I already said that but they were really that bad). He is based in New York and covered by my insurance. It you want a manicure, a pedicure, an espresso in the pre op room and general pampering go to a Beverly Hills clinic; This place is all about a lasting repair at a reasonable price (my bill was much less than the initial quote) with minimal fuss, and, critically, NO MESH. Reading your comments put some things into perspective for me. If their procedure was outdated/inappropriate in anyway, then why are they still in business helping 7000 healthy, wealthy and skinny people (morale issue again) per year have pain free and hernia free lives? Im probably an anomaly in the hernia world, but my story is horrific and Im still passing through it. OUR PATIENT CARE When you come to Shouldice, you can expect to have a positive and pleasant experience. The Shouldice Clinic is a private clinic operating in the Toronto area which has been open for decades. One patient told me he didnt want to go back to Shouldice with his recurrence because he couldnt afford it. My concern is with the use of mesh on a growing teenage boy. I would suspect you will look back at the experience with a fondness when it is all over even I also drove up both times. There is a limit of 2 visitors per patient. Im on the fence with going back to Shouldice or going with the local doctor. Also, I would check w your insurance company before travelling. Go for the weight loss and then go for the surgery!! I agree that the beds are uncomfortable and some of their routine seems a bit military and dated, but I was very confident in their abilities and a few days of discomfort at a hospital is nothing compared to the long term results. I have put off surgery for four years because of concerns with mesh. Should I wait or should I see a surgeon right away? My father, a neighbour, and a former co-worker have had hernia repairs in the last few years. Which must annoy surgeons who use only mesh). Is this because Shouldice thinks this is good care? We all want the best, most cost effective public system but critiques must look at the whole system. I have been there two times for both right and left side repairs. Or that you are cynically making a play for a vast damages pay out. Choose your surgeon carefully. And I appreciate that is frustrating when Shouldice info is hard to get but I can tell you follow up & accurate reporting of success rates for the rest of the system is just as unreliable because of useless record keeping. You . Thank you so much for your time. Since 1945, we have been gathering data from our follow-up examinations. Laparoscopic repairs are reported to have the lowest occurrence of chronic pain in the papers that I read. Ive tried to get surgery twice. Im looking forward to lesmcc1s response. As a specialist, I am not allowed tobill OHIP to seepatients without a referral from another doctor, and so we see the double standard growing. So do you feel that in my case atleast, it might be worth giving Shouldice a first shot or is their antiquated technique simply not worth it as the hernia will in all likelihood recur and then mesh would be the only way to go? But I wonder if I will be told I need to have mesh after all. I got a colleague to do it, with mesh, and a general anesthetic, as day surgery, in one of our local hospitals. shouldice clinic wait times. my surgeon said it was mostly a bunch of people complaining looking for money. The Shouldice clinic is a good example of that. 3) Shouldice use sutures only, minimising foreign material being implanted into body, hence minimising most of afore mentioned risks associated with nerve damage. That is frustrating for you. 1/2-5/8 of flesh mounded above the underlying muscular tissue fix. Have you or your staff followed up with all your patients? However, it is also undeniable that the chance of a hernia recurring over time is reduced when mesh is utilized appropriately and on the right patient. In fact, I believe in less than a decade the medical profession will be inundated with increasing problems from meshes installed in patients 20+ years pervious and will be forced to go back to training their surgeons to the standard they were at pre-1990s, before mesh became mainstream, when hernias were repaired the way they should still be getting repaired today suturing.

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