Panel No. 4
The Shouldice repair approximates the Transversus Abdominis Arch to the lateral edge of the Transversalis Fascia and inguinal ligament. A total of 4 continuous rows are fashioned using a flexible suture. This reinforcement of each successive row above the previous one serves to strengthen the repair and reduce the potential for a failure of the repair. The repair line is sutured snugly up to the internal ring where the spermatic cord emerges in order to prevent any herniation here.
While the Shouldice Clinic continues its historical use of a thin gauge wire suture, it is inflexible contrary to the high flexibility of modern day monofilament sutures. The Hernia Center of Ohio uses only a polybutester suture due to its excellent stretch characteristics and inertness. Additionally, our modification of the Shouldice repair does not remove the genital nerve nor do we divide the cremaster muscle that can result in a drop of the testicle.
Most other techniques of hernia repair today simply cover the hole with a very large foreign material that can lead to numerous complications. The concept of the Shouldice repair is to close the “hole” with your own tissue-never any mesh thereby restoring the normal physiologic properties of the tissue.