The Shouldice repair for inguinal hernia is superior to simple tissue-based repairs because it involves:
- A Four-layer continuous suture repair of the posterior inguinal wall (transversalis fascia and conjoint tendon in two layers each), creating a durable structural reconstruction ✓
- B Preperitoneal mesh placement guided by an anterior open approach
- C Reinforcement of the internal inguinal ring with a prosthetic plug
- D Division and ligation of the ilioinguinal nerve to reduce post-repair pain
Correct answer: A. Four-layer continuous suture repair of the posterior inguinal wall (transversalis fascia and conjoint tendon in two layers each), creating a durable structural reconstruction
Explanation
The Shouldice repair is a non-mesh tissue repair that achieves excellent results through a meticulous four-layer continuous imbrication of the posterior inguinal wall — beginning with division and double-breasting of the transversalis fascia, then suturing the internal oblique/conjoint tendon to the inguinal ligament in two further layers. When performed at the Shouldice Hospital, recurrence rates are <1%, approaching mesh repair results. It does not use prosthetic mesh. The ilioinguinal nerve is not routinely divided.
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.