The standardized Shouldice procedure

Summary 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.