• 1. Einleitung
  • 2. Chirurgischer Ansatz
  • 3. Einschnitt
  • 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. Schließung
  • 13. Bemerkungen nach dem Op
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Shouldice Repair for Left Direct Inguinal Hernia

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

Procedure Outline

  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