Frequently Asked Questions

At Shouldice Hospital, we set high standards. Our surgeons are fully qualified and licensed to perform surgery by the appropriate Canadian authorities. Then they are required to spend up to 6 months of intensive training in the Shouldice Technique to perfect their skills before they are approved to lead a Shouldice surgical team. Only surgeons practicing at Shouldice Hospital receive this training. The Shouldice technique is very detailed and must be practiced in high volumes to ensure consistently superior results.

Most general surgeons will repair 20 to 30 hernias in a year. Shouldice surgeons average over 700 cases a year, which provides the highest level of practice and experience in the world. This is why Shouldice surgeons are the world‘s most experienced leaders in hernia repair

Surgeons come from around the globe to observe the Shouldice technique. For two or three days, they can watch as the Shouldice repair is performed by Shouldice specialists. However, this is not training. Although many surgeons perform hernia repairs, we cannot offer a training program for them. As a result, we cannot guarantee the quality of any hernia repair said to be a Shouldice repair when it is performed by doctors outside of our hospital.

No, you do not need a referral or an appointment for a hernia examination at Shouldice. All you have to do is to come to our examination clinic for a hernia examination. Or, if you live more than 1 1/2 hours (150 km/90 miles) away from the hospital, simply complete the medical questionnaire and fax, mail or e-mail it to us for review.

First, you must have an examination at our hospital or submit a completed medical questionnaire for review by one of our surgeons. Admission dates are scheduled as conveniently as possible and we will make every effort to accommodate your preferred admission date. Please keep in mind that your admission will depend on the space we have available and on specific medical criteria, such as your general health, your weight and the status of your hernia.

Pain and swelling in the groin can have many different causes. A hernia can sometimes be quite difficult to identify and diagnose. In fact, over 1,000 patients a year come to Shouldice, convinced that they have a hernia when they really have a groin strain. If you think you have a hernia, come to our walk-in clinic for an examination by one of our hernia specialists. They have the experience and expertise to give you a proper diagnosis and may even be able to help you avoid an unnecessary operation.

We know that losing weight can be a difficult task, especially if your hernia is limiting your ability to exercise. However, managing your weight helps to get your body in shape so that you will get the best results from your operation. Achieving a reasonable weight contributes to the success of your hernia repair.

When you are overweight, fat builds up over your abdominal wall, making it more difficult for the surgeon to reach and repair the hernia. Fat can also collect in your muscles. Abdominal fat is very soft, like pudding or Jell-O, and has no strength. As the fat collects, it weakens your abdominal muscles, making your hernia repair less secure and increasing your chances of complications. The Shouldice Diet will help to prepare and improve your muscle tissue to ensure the best possible condition for a successful repair.

An important lifestyle change

We have decades of evidence to prove that you will be more satisfied with the results of your hernia repair if you achieve your weight loss goals. By following our special diet, you can improve your muscle quality and reduce your risk of complications.

We have a registered dietitian on staff who is very experienced in helping people get ready for their hernia operations. She can help you make healthy choices and will follow up with you by phone to encourage you and monitor your progress.

Many of our patients have benefited so much from our weight loss program that they have made a long-term commitment to maintaining a healthier weight. Getting your body in shape for your hernia repair may be just the motivation you need to change your lifestyle for the better. We know you can do it, and we‘re always there to help if you need it!

At Shouldice Hospital, we specialize exclusively in external abdominal wall hernias. We are experts in treating the following types of hernias:

• Indirect and direct inguinal hernias
• Recurrent hernias
• Femoral hernias
• Epigastric hernias (sometimes known as ventral hernias)
• Incisional hernias
• Spigelian hernias
• Umbilical hernias

However, there are several types of hernias that we do not repair. If you have one of the following hernias, contact your doctor for treatment or referral to an appropriate specialist:

Hiatal or hiatus hernia

In this type of hernia, the stomach bulges up into the chest through the hiatus. The hiatus is an opening where the esophagus (food pipe) passes through to connect the throat to the stomach.

Parastomal hernia

A parastomal hernia occurs when part of the intestine bulges through the abdominal muscles around a stoma. A stoma is an artificial opening in the abdomen, used to transfer waste products, such as feces or urine, to a small pouch outside the body. A stoma may be necessary for people with certain types of medical conditions, such as bowel cancer, Crohn’s disease or kidney disease.

Herniated Disc

The bones in the spine are cushioned by soft, spongy discs. When one of these discs is damaged, some of the soft, inner material may bulge out, causing back pain and irritation. This is known as a herniated or ruptured disc.

Flank or Lumbar Hernia

This type of hernia is fairly rare and usually develops after an operation or injury to the side of the abdominal wall. It usually causes pain in the low back and leg.

Sports Hernia

This condition, known also as Gilmore’s Groin, is not actually a hernia, but more of a severe groin strain and can be treated with therapeutic management. It may not require surgery.

Hernias can, on occasions, be difficult to diagnose. They can be present and then disappear. When this happens, the hernia does not repair itself, rather, the hernia defect, or hernia sac, simply goes back inside your abdomen through the same weakness in the abdominal wall – the weakness however, remains until it is surgically repaired.

Hernias may be identified by Ultrasound, CT scan or MRI (all of which are rarely needed) but the most reliable way is by a physical exam by a surgeon experienced in hernia repair. Diagnostic imaging “may” show that there are protrusions in the abdominal wall, but they cannot always differentiate the size of the actual hernia defect, or, whether the protrusion is a hernia versus a natural fold of the abdominal wall. Shouldice surgeons see hundreds of patients a year where initial diagnosis based on imaging confirmed the existence of a hernia, when in fact no hernia was clinically present. In these cases it may be better to wait and see if an actual hernia presents itself rather committing to unnecessary surgery.

As well, the absence of a hernia on a diagnostic image does not in itself mean there is no hernia, as surgeons at Shouldice encounter cases where imaging was negative for a hernia when, in fact, a hernia was present on examination.