Suture Inguinal hernia repair

• Method
  • Bassini
  • Shouldice
    • Division and double breasting of transversalis fascia
    • Then suturing conjoint tendon to inguinal ligament with continuous suture
  • Marcy
    • Simple deep ring closure

Advantages and Disadvantages

• Advantages
  • Can be performed under local anaesthesia
  • So Age is never a factor
  • Minimal equipment necessary
  • Most cost-effective repair
  • Incidence of dysejaculation and inguinodynia seen less frequently with pure tissue repairs
• Disadvantages
  • Inadequate in the treatment of femoral hernias
  • Basic pathology of herniation is not addressed
  • Higher incidence of testicular atrophy - more skeletonisation of cord
  • 1% incidence of chronic pain lasting beyond a year after surgery
  • Cannot be relied upon for recurrent inguinal hernias

Bassini Repair

• The Bassini technique for inguinal hernia repair involves suturing the transversalis fascia and the conjoined tendon to the inguinal ligament behind the spermatic cord with monofilament nonabsorbable suture.
• It also involves the so-called Tanner slide, which is a vertical relaxing incision in the anterior rectus sheath intended to prevent tension.

Shouldice repair

• Four-layer inguinal hernia repair performed with the patient under local anesthesia.
• Transversalis fascia is incised from the internal ring laterally to the pubic tubercle medially, and upper and lower flaps are created. These flaps are then overlapped (double-breasted) with two layers of sutures.
• The conjoined tendon is then sutured to the inguinal ligament, again in two overlapping layers.
  • This reinforces the posterior wall and narrows the deep inguinal ring.
• The Shouldice repair is classically done with a continuous suture of 32- to 34-gauge stainless steel wire, but synthetic monofilaments (eg, polypropylene) can also be used.
• The external oblique aponeurosis is then closed in a double-breasted fashion in front of the spermatic cord.

Shouldice, page 2