The Shouldice Hospital technique

The Shouldice repair is used for all types of inguinal hernia whether indirect, direct, sliding, multiple, recurrent, male or female. Local anesthesia is given in more than 95% of cases. The repair is a modified Bassini. Essential preliminaries are accurate dissection at the internal ring with adequate treatment of any indirect hernia. The cremaster is excised. Accurate recognition and definition of the transversalis plane is routine and fundamental. Essentially the repair is an overlap of the divided transversalis plane utilising 4 lines of continuous monofilament stainless steel wire 34 gauge. Patients, ambulant immediately, stay in hospital 2-3 days postoperatively. A large personal series of more than 20,000 inguinal repairs performed almost exclusively in this hospital during a 30 year period from 1954 to 1984 is tabulated. Recurrence rates of less than 1% for repair of primary inguinal hernia and re-recurrence rates of 2-4% for repair of recurrent inguinal hernia are reported. Surgeons in other countries now employing this technique achieve comparable results, often using other non-absorbable suture material.