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  • Title
  • 1. Introduction
  • 2. Surgical Approach
  • 3. Incision
  • 4. Exposure of External Oblique
  • 5. Mobilization of External Oblique
  • 6. Inguinal Dissection and Identification and Preservation of Nerves
  • 7. Skeletonize Cord Structure and Look for the Indirect Hernia Sac / Peritoneum
  • 8. Skeletonize Hernia Sac and Examine Internal Inguinal Ring and Peritoneum
  • 9. Division of Cremaster Muscle Fibers with Genital Branch of Genitofemoral Nerve
  • 10. Divide Floor of Inguinal Canal
  • 11. Four-Layer Shouldice Repair
  • 12. Closure
  • 13. Post-op Remarks

Shouldice Repair for Left Direct Inguinal Hernia

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Divyansh Agarwal, MD1; Lauren Ott, PA-C2,3,4; Michael Reinhorn, MD, FACS2,3,4
1Massachusetts General Hospital
2Mass General Brigham - Newton-Wellesley Hospital
3Boston Hernia and Pilonidal Center
4Tufts University School of Medicine

General Surgery

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Surgical Approach
      1. 3. Incision
        1. 4. Exposure of External Oblique
          1. 5. Mobilization of External Oblique
            1. 6. Inguinal Dissection and Identification and Preservation of Nerves
              1. 7. Skeletonize Cord Structure and Look for the Indirect Hernia Sac / Peritoneum
                1. 8. Skeletonize Hernia Sac and Examine Internal Inguinal Ring and Peritoneum
                  1. 9. Division of Cremaster Muscle Fibers with Genital Branch of Genitofemoral Nerve
                    1. 10. Divide Floor of Inguinal Canal
                      1. 11. Four-Layer Shouldice Repair
                        1. 12. Closure
                          1. 13. Post-op Remarks
                            1. Inject Local Anesthetic
                            1. Inject More Local Anesthetic
                            1. Inject More Local Anesthetic
                            2. Inject More Local Anesthetic
                            1. Divide the Floor, Comprised of Aponeurosis to Transversus Abdominis and Transversalis Fascia (Often Fused)
                            2. Excise Redundant Transversalis Fascia (if Present)
                            3. Check for Femoral Hernia
                            1. Layer One: Rectus Abdominis to Transversalis Fascia with Anchor to Inguinal Ligament
                            2. Incorporate Internal Oblique, Cremaster Bundle, and External Oblique to Recreate Internal Ring
                            3. Confirm the Internal Ring is Appropriate
                            4. Layer Two: Internal Oblique Muscle and Rectus to External Oblique Fascia
                            5. Layer Three: Close Reinforcement of Internal Oblique and Rectus to External Oblique
                            6. Layer Four: Wide Reinforcement of Rectus to External Oblique
                            1. Reposition Spermatic Cord Back in Place
                            2. Close External Oblique
                            3. Close Scarpa's Fascia
                            4. Close Skin

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                            Authors

                            Filmed At:

                            Newton-Wellesley Hospital

                            Article Information

                            Publication Date
                            Article ID340
                            Production ID0340
                            Volume2022
                            Issue340
                            DOI
                            https://doi.org/10.24296/jomi/340