Editing Inguinal hernia (section)

=== '''Shouldice repair:''' ===

* Modification of Bassini repair - probably the most enduring version
* Most extensively studied of open repairs, and generally recommended if non-mesh repair is taking place
* Essentially release the inguinal floor and then close it in four layers
* Method as per Gray's:
** Need to expose more than for a mesh repair, especially EO. Often need to move iliohypogastric superiorly to avoid catching it.
** Open inguinal floor (transversalis fascia opened between internal ring and pubic tubercle)
** Option to use a 'scarf' of lateral cremaster muscle sutured up to to re-create the deep inguinal ring
** Repair layers:
*** '''1: Starting from medially, suture lateral edge of rectus abdominis down to bottom flap of TA/TF''', and continue this laterally until lateral edge of rectus is reached.
*** 2: More laterally to rectus, '''fix free edge of upper flap of TA and IO to inguinal ligament to become the new medial wall of deep ring'''. Include the 'scarf' medial to internal ring, brought out behind the cord.
*** 3: moving back from deep ring towards pubic tubercle, '''bring conjoint tendon (IO and TA) together with the inguinal ligament'''. Tie back to the tail of the original suture.
*** ''Can stop there, or continue for another back and forth suture line.''
*** 4: '''Suture from lateral medial, initially just mass closure of the previous suture line, then an imbricating suture back''', tied to itself.