Shouldice

The Shouldice technique of suture only hernia repair was developed by Dr. E. E. Shouldice at his clinic dedicated to hernia surgery in Toronto, Canada. This repair became widely acclaimed as the "gold standard" of open repairs in the 1980's, and was a favored repair across North America and Europe. The essential steps in this repair were first described by Dr. Robert Moran in 1968 , and include: local anesthesia, ligation of the indirect sack, resection of the cremasteric fibers, incision of the entire posterior wall of the inguinal canal, double layer closure of the transversalis fascia with running continuous stainless steel sutures, a second double layer closure of the internal oblique muscle to the inguinal ligament, and relaxing incisions when indicated. The second double layer in the internal oblique muscle has little strength but is utilized to reduce the tension on the first two layers that were sutured in the transversalis fascia. An extremely detailed description of the dissection and precise suturing of this technique is presented by Dr. Bendavid, in Nyhus and Condon's text "Hernia".

1. "Surgical treatment of hernia" Shouldice. Annual meeting of the Ontario Medical Association, District number 9, Sept 10, 1944
2. "Shouldice inguinal hernia repair in the male adult: The Gold Standard? A multicenter controlled trial in 1578 patients" Hay, Boudet, Fingerhut, et al. Annals of Surgery 222(6):719-727, Dec 1995
3. "Double layer of transversalis fascia for repair of inguinal hernias: results in 104 cases" Moran, Blick and Collura. Surgery 63(3):423-429, 1968
4. "The Shouldice Repair" Bendavid. Chapter 12: "Hernia" fourth edition, Nyhus and Condon. J.B.Lippincott, Philadelphia, pp217-227, 1995