The Canadian repair: personal observations

Abstract

The Canadian hernioplasty is the modern equivalent of the original Bassini operation. Most of the criticism of the repair is unjustified, even the fact that the repair does not address the femoral canal. The incidence of the femoral type of recurrence that typically occurs in the first year was only 0.14% among the 4,366 primary Canadian hernioplasties performed by one surgeon in the years 1970 to 1987. There were a total of 58 recurrences for a raw recurrence rate of 1.3%. About half of the recurrences were considered to be failures of the hernioplasty, and the remaining ones were attributable to continued deterioration of the patient's tissues. This huge experience of one surgeon demonstrates that recurrence rates, to a great extent, depend on the skills of the surgeon. Recurrence rates decrease as a surgeon's experience with the procedure increases. It also demonstrates the importance of technique and how a minor change in the method of beginning the continuous suture reduced suture tension and eliminated the well-known pubic tubercle type of recurrence seen after all hernioplasties. The recurrence rate for 639 recurrent and rerecurrent hernias repaired by Canadian hernioplasty was 7.2%. This rate is unsatisfactory, and a preperitoneal repair with a polyester prosthesis is preferred for these difficult problems. A local agent neutralized with sodium bicarbonate is the anesthetic of choice, and simultaneous left and right hernioplasties with the patient going home the same day as the procedure are now commonplace.