Modified Shouldice hernia repair: a study of 421 inguinal herniorrhaphies by a single community surgeon over ten...

The evolution of a technique of inguinal hernia repair, progressively incorporating more modern materials and concepts, is described and evaluated. Anatomic precepts of hernia anatomy put forth by Condon form the foundation of this technique. The Shouldice methodology dominates the original plan of patient management but more modern suture materials and local anesthetics afford even greater ease and efficiency to this hernia repair plan. The results of 421 herniorrhaphies done by the primary author over ten years are reported with three patients lost during follow-up (0.7%). No cases are included unless a minimum of three years since surgery has elapsed. The unselected recurrence rate is 2.77 per cent. All ten recurrences are studied and related to changes in surgical technique. Cost effectiveness goals such as early discharge and same-day surgery are also discussed as they apply to this approach.