The shouldice repair for inguinal hernia - technique and results

The technique of the Shouldice hernioplasty for primary and recurrent inguinal hernia is described on the basis of more than 3 500 procedures at the Surgical University Clinic of Aachen and 700 operations performed at the Surgical Department of the Park-Klinik Berlin-Weissensee. Local anesthesia is the preferred type of anesthesia with a good acceptance by the patients site (96%). In compliant adults nearly all primary and about 50% of the recurrent hernias can be repaired under local anesthesia. Essentials of the preparative phase are identification and preservation of the inguinal nerves, resection of the cremaster muscle and exposure of all three hernial sites (lateral, medial and femoral). For all primary hernias and indirect or small recurrent hernias a modified two-layer Shouldice repair of the transversalis fascia using a monofilament running suture (Polypropylene 0) is recommended. In the early postoperative period the physical activity is limited only by the patients complaints. Normal activity is gained back within 2 to 3 weeks. In a non selected group of patients 10-years recurrence rates are 2.6% in primary hernia and 6.9% in recurrent repair. The Shouldice repair is recommended as the procedure of choice for all primary and selected recurrent hernia. A mesh prosthesis may be necessary in large medial and combined recurrent hernia.