What is the Shouldice repair technique for open inguinal hernia repair?

Updated: May 21, 2021
  • Author: Vinay Kumar Kapoor, MBBS, MS, FRCS, FAMS; Chief Editor: Kurt E Roberts, MD  more...
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The Shouldice technique is a four-layer inguinal hernia repair performed with the patient under local anesthesia. The transversalis fascia is incised from the internal ring laterally to the pubic tubercle medially, and upper and lower flaps are created. These flaps are then overlapped (double-breasted) with two layers of sutures.

The conjoined tendon is then sutured to the inguinal ligament, again in two overlapping layers. This reinforces the posterior wall and narrows the deep inguinal ring. The Shouldice repair is classically done with a continuous suture of 32- to 34-gauge stainless steel wire, but synthetic monofilaments (eg, polypropylene) can also be used. The external oblique aponeurosis is then closed in a double-breasted fashion in front of the spermatic cord.

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