Guest, the Shouldice technique IS used in the US. It's one of the two common techniques for repairing inguinal hernias. (Which, by the way, Donuel does NOT have...so you can ignore all the discussion about Shouldice, Donuel!) The other, newer, procedure, is called the Lichtenstein technique, which uses a prosthetic patch and/or plug to close the defect. And, according to a prospective randomized study published in the British Medical Journal, the Lichtenstein is better than the Shouldice:

BACKGROUND: The aim of the present randomized trial was to compare the Shouldice procedure and the Lichtenstein hernia repair with respect to recurrence rate, technical difficulty, convalescence and chronic pain. A further aim was to determine to what extent general surgeons in routine surgical practice were able to reproduce the excellent results reported from specialist hernia centres.

CONCLUSION: Lichtenstein hernia repair was easier to learn, took less time and resulted in fewer recurrences. It was possible to achieve excellent results with this technique in a general surgical unit.

Now, the Shouldice method, as opposed to technique, means doing what Dr. Shouldice did in the 1940's: dedicating an entire hospital to one surgical procedure. The Shouldice website, linked to by bobad, likens their hospital to a sort of "medical factory." They state, correctly, that factories of any sort which specialize in one procedure or product generally do a better job at it than those which do or make many different things. Here's a quote from their website:

For over a decade professors at Harvard Business School have been teaching the merits of focus in business to their MBA and EMBA students. Harvard's concept of the "Focused Factory", a business that concentrates on the practice to perfection of one clearly defined process, is so well regarded that over 75 of the worlds leading business schools have adopted it in their own teachings. The philosophy is capsulized and highlighted in a service oriented case study about Shouldice Hospital, written by Harvard professor James Heskett and Mr. Alan O'Dell, the managing Director of Shouldice.

Subsequent to the case study, two books have been written by Harvard professors which feature the Shouldice example for the same purpose. The books are "Market Driven Health Care" by Regina Herzlinger and published by Addison Wesley and "The Service Profit Chain" by James Hesker, Earl Sasser and Leonard Schlesinger and published by The Free Press.

We haven't generally approached medical procedures this way in the US or Canada, with the exception of the Shouldice hospital, and the more recent example of specialized centers for ophthalmologic procedures like Lasik. It does make sense, and I have nothing against it, but it's not for everybody, and certainly not for every problem.

So don't get your knickers in a knot about an apparent "conspiracy" by American medicine to limit the use of a successful surgical procedure. It ain't so...and in fact, the procedure isn't any more successful than the alternative.

The most important thing is to have a surgeon whom you trust and with whom you can communicate...and who does your particular operation with some frequency.

Aloha,
Mark