The Shouldice repair for inguinal hernia is a tension-based technique that involves reinforcement of which specific structure in multiple layers?

• A The anterior wall of the inguinal canal using the external oblique aponeurosis
• B The conjoint tendon sutured to the inguinal ligament (Bassini-type repair)
• C The internal oblique muscle reinforced with a Lichtenstein mesh
• D The posterior wall of the inguinal canal (transversalis fascia) in four overlapping continuous suture layers ✓

Explanation

The Shouldice repair is a multilayer non-mesh technique where the transversalis fascia (posterior wall of the inguinal canal) is divided, then repaired in four overlapping continuous suture layers using monofilament non-absorbable suture. This creates a durable tension-free reconstruction of the internal ring and posterior wall. The Shouldice technique is associated with one of the lowest recurrence rates among pure tissue repairs (1–2%). It differs from Bassini's repair (single layer conjoint tendon to inguinal ligament) and from the Lichtenstein repair (mesh-based).

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.