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Encyclopedia > Shouldice Hernia Centre
Shouldice Hernia Centre
Location
Place Thornhill Ontario, (Canada)
Organisation
Care System Private
Hospital Type Specialist
Affiliated Med.Sch. Unknown
Services
Emergency Dept. No
Beds Unknown
Speciality Hernia repair
History
Founded Unknown
Links
Website Homepage
See also Hospitals in Canada

Shouldice Hernia Centre is a hospital in Thornhill, Ontario, Canada, that is known for its specialization in external abdominal hernia operations. Shouldice uses a technique developed during World War II by Dr. Edward Earle Shouldice. Their ten full-time surgeons perform over 7500 hemiorrhapies each year. The facility, which looks much like a mansion, is purposely comfortable, featuring a 23-acre property. The hospital focuses on customer service, without compromising on speedy recovery. The centre is owned by Shouldice Hospital Limited. Thornhill is a former village in Ontario, Canada, directly north of Toronto and about 25 km (15 miles) north of Downtown Toronto, and is currently shared by two municipalities, the city of Vaughan having the portion west of Yonge Street and the town of Markham having the eastern portion. ... Motto: Ut Incepit Fidelis Sic Permanet (Latin: Loyal she began, loyal she remains) Official languages English Flower White Trillium Tree Eastern White Pine Bird Common Loon Capital Toronto Largest city Toronto Lieutenant-Governor James K. Bartleman Premier Dalton McGuinty (Liberal) Parliamentary representation  - House seats  - Senate seats 106 24 Area Total... It has been suggested that this article or section be merged with Health care. ... A physician visiting the sick in a hospital. ... A physician visiting the sick in a hospital. ... A university hospital is an institution which combines the services of a hospital with the education of medical students and with medical research. ... The emergency department (ED), sometimes termed the emergency room (ER), emergency ward (EW), accident & emergency (A&E) department or casualty department is a hospital or primary care department that provides initial treatment to patients with a broad spectrum of illnesses and injuries, some of which may be life-threatening and... A hernia is a protrusion of a tissue, structure, or part of an organ through the muscular tissue or the membrane by which it is normally contained (definition from MeSH). ... This is a list of hospitals in Canada. ... Thornhill is a former village in Ontario, Canada, directly north of Toronto and about 25 km (15 miles) north of Downtown Toronto, and is currently shared by two municipalities, the city of Vaughan having the portion west of Yonge Street and the town of Markham having the eastern portion. ... A hernia is a protrusion of a tissue, structure, or part of an organ through the muscular tissue or the membrane by which it is normally contained (definition from MeSH). ... Combatants Major Allied powers: United Kingdom Soviet Union United States Republic of China and others Major Axis powers: Nazi Germany Italy Japan and others Commanders Winston Churchill Joseph Stalin Franklin Roosevelt Harry Truman Chiang Kai-Shek Adolf Hitler Benito Mussolini Hideki Tojo Casualties Military dead: 17,000,000 Civilian dead...


The facility was subject of a 1983 business case by the Harvard Business School. Written by professor James Heskett, the report is currently the school's fourth-best-selling business case, selling nearly 260,000 copies. Twenty thousand students at 500 universities worldwide read about the centre annually, as part of their curriculum. HBS, as seen from across the Charles River. ...


Shouldice launched a website in 1995. Over 300,000 visit the site each year; each year 1300 operations are scheduled online, and close to 10,000 emails requesting information are received.


In 2000, former Prime Minister of Canada Joe Clark revealed he had attended the facility in the 1980s. Charles Joseph Joe Clark, PC, CC, AOE, MA, LLD (born June 5, 1939) was the sixteenth prime minister of Canada, from June 4, 1979, to March 3, 1980. ...


During the 2006 federal election campaign, New Democratic Party leader Jack Layton was criticized for attending the facility. As a critic of private healthcare, Layton was actually unaware that the facility was private.[1] The hospital is, however, a non-profit operation, and it has a virtual monopoly on hernia repair in Toronto (Layton is from Toronto). Rendition of party representation in the 39th Canadian parliament decided by this election. ... The New Democratic Party (NDP; Nouveau Parti démocratique in French) is a political party in Canada with a social democratic philosophy that contests elections at both the federal and provincial levels. ... John Gilbert Jack Layton, PC, MP, PhD (born July 18, 1950, in Hudson, Quebec) is a social democrat Canadian politician and current leader of Canadas New Democratic Party (since 2003). ...

Contents

The process

Pre-surgery

Shouldice requires patients to be at an acceptable weight appropriate to their height. Prospective patients who are overweight must lose weight.


Patients enter the hospital the day before surgery and are given a briefing about the procedures to be followed the next day. The night before the operation is also intended as an opportunity for patients to come to know each other – Shouldice encourages patients to work together to promote recovery.


Docters from other institutes constitute a disproportionately higher percentage of patients (I.e. if a docter from the U.S. needs surgery he goes to Shouldice)


Surgery

At most hospitals, surgery takes 90 minutes, but Shouldice doctors take simply 35–40 minutes. Local anesthesia is used in surgeries, instead of general anesthesia, as the second is unnecessary in hernia surgeries, and the first is both safer and cheaper. The procedure most commonly used at Shouldice uses no surgical mesh, which further reduces cost. Local anesthesia is any technique to render part of the body insensitive to pain without affecting consciousness. ...


Most surgeries at Shouldice involve sewing muscle layers together in overlap. The specific technique is often referred to as the Shouldice operation or the Canadian operation.


Recovery

Unlike many hospitals, Shouldice does not have a "fleet of wheelchairs and gurneys, armies of aides to push them, and banks of wide elevators."[2] Instead, carpeted floors, low-rise stairs and beautiful grounds are available, encouraging activity. The Shouldice property comprises 23 acres, with a greenhouse, putting green, sunrooms, pool table, stables, and dining hall. The hospital focuses on customer service, without compromising on speedy recovery. This article is about the sport of golf. ...


The landscaped grounds, pool table, and putting green are all intended to encourage patients to be mobile following surgery – to take walks in the grounds and to stretch and bend while playing pool or practising putting. Similarly, there are no television sets or telephones in patients' rooms and beds have to be adjusted manually. A daily exercise program is also provided.


Patients are scheduled stay in the hospital for two days and three nights following surgery, although those who recover faster may leave earlier.


All rooms are double occupancy, and regularly flow through patients. The patient rooms have "low capital investment"—with no phone, television, and minimal medical equipment. The double occupancy rooms also provide income from additional charges for semi-private rooms. These mandatory charges are not covered by public health insurance and effectively make the Shouldice an example of the upper tier of two-tier health care – welfare recipients, for example, cannot be referred there. Two-tier health care is a form of national health care system that is used in most developed countries. ...


Follow-up

Shouldice sends out a newsletter to all of its patients. The newsletter includes a questionnaire for Shouldice's post-operative follow-up program. The program is considered the world's largest and longest-running follow-up program. The post-op is gradually transistioning to e-mail, as much as possible.


Shouldice reports that fewer than 1% of patients have a recurrence after hernia repair. This compares to the 10-15% in normal hospitals.[3] However, a study published in 2005 by two Shouldice surgeons reports a recurrence rate of 8% after three years for mesh repairs. The study also found no effect of preoperational weight loss by obese patients (a Shouldice requirement) on recurrence rate. [4]


Studies carried out outside Shouldice generally show recurrence rates for "Shouldice repairs" (described above) which are higher than the recurrence rates reported by Shouldice. For example, a French study [5] of 1,706 repairs performed using the Shouldice, Bassini's, and Cooper's ligament repairs found that Shouldice repairs had the lowest recurrence rate, but that the rate was 6.1% after 8.5 years. However, the surgeons performing the repairs in these studies are almost certainly less experienced with this type of repair than Shouldice surgeons. For example, in the French study, fewer repairs were performed over six years than would be performed in about three months at Shouldice.


The disparity between the rates claimed by Shouldice and published rates also may be due in part to differences in the length of the post-surgery period assessed. Shouldice does its first follow-up after 18 months. Yearly follow-ups are conducted after that, but there is doubtless loss of contact with many former patients who have moved. The average period since surgery in Shouldice's data may therefore be shorter than the periods in published studies.


Shouldice holds annual patient reunions, which one year attracted 1500 former patients.


Primary staff

  • Byrnes Shouldice, co-owner, president, chairman, former surgeon at the facility
  • Germaine Urquhart, co-owner
  • Daryl Urquhart, director of business development and grandson of the founder
  • Dr. Cassim T. Degani, MB, BS, MS, FRCSC, FACS, Chief Surgeon, Shouldice Hospital
  • Dr. Ram K. Singal, MB, BS, FRCSC
  • Dr. Earle Byrnes Shouldice, MD
  • Dr. Michael A. Alexander, MB, BS, FRCSC, FACS
  • Dr. Chin K. Chan, BS(Hon), MD, CM, CSPQ, DABS, FRCSC
  • Dr. Richard T. Sang, MD
  • Dr. Keith Slater, MD
  • Dr. Rasheed. A. Affifi, MB, ChB, FRCSC
  • Dr. N. Ross, MD
  • Dr. Lisa Plow-Jarvis, MD
  • Dr. N. Hadjis, MD, FRCS, FRCSC

Notable patients

Charles Joseph Joe Clark, PC, CC, AOE, MA, LLD (born June 5, 1939) was the sixteenth prime minister of Canada, from June 4, 1979, to March 3, 1980. ... John Gilbert Jack Layton, PC, MP, PhD (born July 18, 1950, in Hudson, Quebec) is a social democrat Canadian politician and current leader of Canadas New Democratic Party (since 2003). ...

Trivia

  • A season one episode of Monk featured the Shouldice grounds in exterior shots.
  • Shouldice was used as the White House in the movie: Murder at 1600

A monk is a person who practices asceticism, the conditioning of mind and body in favor of the spirit. ...

Further reading

  • Bendavid R, The Shouldice Repair. Inguinal Hernia Repair, eds: Schumpelick V, Wantz GE. Basel, Karger, 1995, pp 122-134.
  • Bendavid R, E.E. Shouldice: A Biography. Problems in General Surgery, Vol 12, No 1, pp 1-5. Lippincott-Raven, Philadelphia, 1995.
  • Bendavid R, The merits of the Shouldice repair. Problems in General Surgery, Vol 12, No 1, pp 105-109. Lippincott-Raven, Philadelphia, 1995.
  • Bendavid R, Activity following herniorrhaphy. Inguinal Hernia Repair, eds: Schumpelick V, Wantz GE. Basel, Karger, 1995, pp 310-311.
  • Bendavid R, Expectations of hernia surgery (inguinal and femoral). Principles and Practice of Surgical Laproscopes, ed. Simon Paterson-Brown and James Garden, W.B. Saunders Publishers, 1994 London, UK.
  • Welsh D, Alexander M, The Shouldice Repair. Surgical Clinics of North America, Vol 73, No 3, June 1993, pp 451-469.

Notes

  1.   John E Martin, Command Performance. Boston: Harvard Business School Press. ISBN 0-87584-562-2
  2.   Atul Gawande, Complications: A Surgeon's Notes on an Imperfect Science. New York: Picador, 2002. ISBN 0-312-42170-2
  3.   G. Chan & C. K. Chan. A review of incisional hernia repairs: preoperative weight loss and selective use of the mesh repair. Hernia, 2005. 9 (1), 37-41 Abstract
  4.   J. M. Hay, M. J. Boudet, A. Fingerhut, J. Poucher, H. Hennet, E. Habib, M. Veyrieres, Y. Flamant. Shouldice inguinal hernia repair in the male adult: the gold standard? A multicenter controlled trial in 1578 patients. Ann. Surg., 1995 (Dec);222(6):719-27. Abstract

See also

  • Hernia
  • Lichtenstein Hernia Institute

 
 

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