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The standardized Shouldice procedure
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DOI：10.1007/s10353-026-00929-x.png)
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Abstract
En 中文
The Shouldice technique is a standardized, open, mesh-free procedure for inguinal hernia repair developed by E.E. Shouldice and refined at the Shouldice Hospital in Canada. In the absence of a universal gold standard for groin hernia surgery, it remains an important option, particularly for patients who prefer a non-mesh repair. The operation can usually be performed under local anesthesia and requires meticulous anatomical dissection.The central element of the procedure is a four-layer reconstruction of the posterior inguinal wall using a continuous suture technique. This multilayer repair provides strong reinforcement and controlled reconstruction of the internal inguinal ring. Recent high-volume studies report recurrence rates of approximately 1.6%, comparable to established mesh-based techniques. Updated HerniaSurge guidelines confirm similar short-term outcomes to Lichtenstein and laparo-endoscopic repairs in carefully selected patients when expertise is available.
Keywords:
Shouldice repair
Tissue repair
Non-mesh repair
Suture-based repair
Inguinal hernia repair
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