Page 31 - herina surgery and possible lawsuits

Shouldice repair: E. Shouldice (1891-1965), Toronto reported his technique of repairing

inguinal hernia by overlapping layers with a continuous suture. He used transversalis fascia,
along with both anterior and posterior lamina, arranged in three distinct layers and then
repaired the opening, in each layer in turn, by overlapping its margins rather than by stitching

them together edge-to-edge. The end result is to reinforce the muscular wall of the abdomen
with six rows of suture." This technique has performed masterfully at the Shouldice clinic,
with recurrence rates of less than 1%.[9, 23]

Figure 7a: Shouldice repair - First layer.
Dissection showing ligated cremasteric
stump, lower flap edge sutured with inner

aspect of upper flap. (Courtesy: Nyhus &
Condon’s HERNIA. 5e, LWW)

Shouldice repair - Second

Upper flap edge sutured with outer edge

of the sutured lower flap. (Courtesy: Nyhus
& Condon’s HERNIA, 5e. LWW)

McVay repair (Cooper ligament repair):

• Cooper was the first to describe the superior pubic ligament, although he never used it
to repair surgically a groin hernia.
• The first Cooper ligament repair done in 1897 by the Austrian surgeon, Georg
Lotheissen, who used the superior pubic ligament in 2 patients who had lost their
inguinal ligaments in the course of prior unsuccessful hernia repairs.
• McVay and Anson revived Lothiesson's operation in 1942. They considered the
superior pubic ligament to be the ideal structure for reconstructing the posterior wall
of an inguinal hernia, since it shares the same tissue plane and derived from the same
tissue origin as the transversus aponeurosis and the transversalis fascia. They advised
suturing the transverse abdominis arch to Cooper's ligament for repair of inguinal

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