The management of elective hernia repair

The history of Shouldice Hospital and the technique of herniorrhaphy used there are described briefly. The main thesis is that the morbidity and mortality from adult elective hernia repair in the Province of Ontario are needlessly high; both could be drastically reduced if local infliltration anesthesia became the accepted routine, combined with immediate ambulation and a genuine program of ensuing physical activity. Economic considerations apart, the advantages of outpatient herniorrhaphy are questionable.