Why not Shouldice ?
By Dr. Desarda
WHY NOT SHOULDICE OR BASSINI OR MACVAY?
These all repairs are called as “Tension repairs”
The surgeon would close the defect by stitching muscle above firmly to the inguinal ligament below to close the defect. This creates tension in the muscles even at rest which gets aggravated many fold during the acts of coughing or straining. Secondly, this displaced muscle by natural virtue would try to go back to its original place over a period of time. Already weak muscle gets weaker by suturing it under tension and repair with such weak muscle fails to give any life time protection even if they are securely sutured like in Shouldice or MacVay’s. Natural scarring of tissues and its shrinkage will further increase the tension and also weaken the tissues, resulting in to a high level of recurrences. The repair of this recurrent hernia is therefore a larger operation than the first and the results proportionately more uncomfortable.
Unfortunately, this will cause tension and subsequent pain with all movements (including coughing and sneezing). Patient depends upon this stitching for the rest of his life to hold the abdominal wall closed, the surgeon would normally have to place several stitches, under a degree of tension in the deep tissue, repeating the process until he is satisfied that the join will hold. He is therefore restricted in physical activity for some weeks.
In order to reduce the tension of the stitching, surgeons developed many methods of stitching the tissue in layers, one above the other like Shouldice. This technique reduced a little of the pressure, but resulted – by definition – in more stitching through the patient’s tissue. You can imagine the degree of throttling and necrosis of the muscle or ligament of 1-2 mm width when they are stitched again and again in 4 layers with synthetic threads or fine stainless steel wire. (See through following sketches)
It is possible that some surgeons may use old tension repairs like Bassini or Shouldice under the pretext of mesh free surgery. So always insist for mesh free repair by “DESARDA TECHNIQUE” only