The SHOULDICE operation

This method is very common all over the western world for groin hernia repair.

But as scientific reports show, only few surgeons carry it out in a correct way.
This is the main reason for comparatively high numbers of failure (i. e. : recurring hernias) in non-specialised surgeons.

Our own results and experience since 1989 are very satisfactory with this method.

The operation

This operation is proceeded in “open” surgery, as well in local anaesthesia, as in superficial full anaesthesia. It takes about 30 minutes and is typically carried out as an out-patient case (in our case). There is no mesh implanted: the fascias of the muscles, that are bearing the hole (the hernia) are “folded” so, that a double layer of fascia covers the former hole.

After the operation

Depending on the individual case our patients return to normal life and do sports after only three days .

Number of recurring hernias

In our patients we found the number of recurring hernias to be about 2 –5 % during the first 5 years after surgery (depending on the age, sex and the individual quality of the connective tissue of the patient).
In cases where this method is carried out in already recurring hernias, the number of new relapses is high: About 25 %.

For this reason we normally use different methods in these cases, such as the RUTKOW-method or the LICHTENSTEIN-method.
The method is suited for.
Mainly groin hernias in young patients or the “sportsman's groin” – if the connective tissue is found to be of good quality during surgery.

The RUTKOW operation

This is very common in the US and we have been carrying it out since 1998 with excellent results.
In this operation a light but very strong polypropylene mesh plug is implanted (and fixed with some sutures) in the hole of the groin-wall.
This plug closes the hole very effectively.
Moreover a small, thin but also very strong layer of polypropylene-mesh is laid over the groin-area to augment the wall and protect it for the future.

Anaesthesia

We carry out this quite small, quick and very effective operation in local or superficial full anaesthesia.

Clinical or out-patient-procedure

This operation is ideal for out-patient-treatment.
Only an hour or two after the operation, the patients leave the surgery and go home or in their hotel.

After the operation

Particularly this treatment - if it is proceeded properly by a very skilled and experienced surgeon – allows us to let the patient do whatever he or she likes after only three days. E.g. any sport or work (even farmers).

This operation is specially suited for

Groin hernias in heavy working patients or patients who are really very active in sports, and those cases with relapses.

Long term results

We can now look over the period since 1998, when we first started with this treatment (it was invented about 1997 and we were one of the first institutes to deal with it in Europe). The results are very good, an the number of recurring hernias is very, very small.
The rate is about 1 – 3 % of the cases, which is indeed very good.
This operation, as all the others we explain here, is not our invention and is nowadays quite common in surgery.

The results depend much from the individual skills and experiences of the surgeon and from many little details during the operation – no two RUTKOW-operations are the same (quality).
Our high specialisation and experience – we have treated more than 15,000 surgical cases in the last 11 years – enable us to let the patients do whatever they want after only three days, while other surgeons commonly recommend a break of 6 – 12 weeks.

The LICHTENSTEIN operation

For this surgical procedure a short cut in the groin-region is needed, where a polypropylene-mesh is placed over the hernia (the “hole” in the groin-wall), with or without (depending on the individual anatomic situation) closing the hernia first by a suture.
This operation is, as is also the RUTKOW-procedure, one of the tension-free surgical treatments of a groin hernia. There is no tension on the muscles, as normally after a groin hernia repair.For this reason the patients are able to conduct normal life much earlier and do sports: normally three days after surgery.

The anaesthesia

In many cases only local or regional anaesthesia is needed, in all other cases a slight full anaesthesia is applied.

Clinical or out-patient treatment?

We carry out the LICHTENSTEIN operation normally in out-patients. Only 1 – 2 hours after the operation, our patients leave the surgery to go home or into their hotel. Only a few patients like to or have to spend a night in the clinic (e.g. patients with heart problems).

After the operation

There is always only very little pain and swelling in our patients and the patients are normally able to conduct their normal life and work, as well as doing sports, after only three days.
This is due to the special surgery methods and our high-level experience in this field.
All the methods we use are common in modern surgery, but the results depend strictly on the individual experience of the surgeon and his specialisation.

We have had more than 15 000 surgical cases during the last 11 years and because of this, we can allow our patients to do anything they want after only three days, while normally a break of 6 – 12 weeks is recommended by others.

Long term results

Our long term results are very good in patients of both sexes. The number of relapses is small, the rate is about 2 – 4 % of the cases.

This operation is especially suited for

smaller groin hernias, incipient hernias (“sportsman's groin”), no relapse cases.

Endoscopic operations (TAPP, TEP)

Endoscopic methods are not “first choice” in hernia-repair. Many surgical societies, e.g. the German surgical society, recommends not to use them as standard. These methods should be left for the following cases:

there have been at least one or more relapses after “open” surgery
older patients (but not too old, due to long and deep anaesthesia)

There are two different ways to carry out these endoscopic surgeries:

through the abdominal cave = t rans a bdomino- p eritoneal p lastic = TAPP
through and beneath the abdominal muscles = t otal e xtraperitoneal plastic

Both methods need a deep relaxation of the muscles and therefore a deep anaesthesia.
In both cases quite big (much bigger and heavier, than in “open” surgery) polypropylene-meshes (sometimes coated with titanium) are implanted to close the hernia.
The operation is normally carried out with a stay of two days in the clinic.

Specific complications
Particularly with the TAPP-method, where the endoscopic tube is brought through the whole abdominal cave (through little cuts in the belly button and in the side), theoretically all organs that are there may be injured.
Vascular and intestinal injuries do sometimes occur and may cause dangerous problems.