The Shouldice repair for inguinal hernia achieves low recurrence rates through which specific technical mechanism?

• A Use of a prosthetic mesh placed in the pre-peritoneal space (Rives-Stoppa technique)
• B Simple high ligation of the hernial sac with no floor repair
• C Basini repair reinforced with polypropylene sutures
• D Multilayer non-mesh repair using continuous sutures in four overlapping layers of the transversalis fascia and inguinal floor — a pure-tissue repair ✓

Explanation

The Shouldice repair, pioneered at the Shouldice Hospital in Toronto, achieves its low recurrence rates (1–2%) through a four-layer continuous suture repair that imbricated the transversalis fascia in the posterior inguinal wall, using no mesh. It divides the transversalis fascia from the internal ring to the pubic tubercle, then repairs it in two overlapping layers, followed by two further layers approximating the internal oblique/transversus abdominis to the inguinal ligament. It remains the gold standard tissue repair for comparison against mesh repairs.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.