The Shouldice repair for inguinal hernia uses a specific tissue-based technique. Which of the following best describes its key principle?
- A Four-layer continuous suture repair of the posterior wall of the inguinal canal without mesh ✓
- B Tension-free mesh repair of the posterior inguinal wall using polypropylene mesh
- C Repair using a plug and patch technique inserted into the internal ring
- D Laparoscopic transabdominal preperitoneal (TAPP) repair with large mesh coverage
Correct answer: A. Four-layer continuous suture repair of the posterior wall of the inguinal canal without mesh
Explanation
The Shouldice repair is a tissue-based (non-mesh) repair involving a four-layer continuous suture reconstruction of the posterior wall of the inguinal canal using stainless steel wire or monofilament suture. It involves dividing and overlapping the transversalis fascia, then approximating the internal oblique and transversus abdominis muscles to the inguinal ligament in two further layers. It carries recurrence rates of 1-3% at specialist centres. The Lichtenstein repair is the standard tension-free mesh repair; Plug-and-patch and TAPP are other options.
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.