Tissue and suture repairs of inguinal hernias

Question 1

What are the advantages and disadvantages of suture repair/tissue repair of inguinal hernias?

Answer 1

Advantages: can be used when bowel perforation, infected wounds, when mesh is not possible

Disadvantages: not tension free. Higher recurrence rate

Question 2

Name two types of suture/tissue repair methods for inguinal hernia repair

Answer 2

Bassini
Shouldice

Question 3

What are the principles of a bassini repair?

Answer 3

Reflected portion of the inguinal ligament → inf. edge of tranversalis fascia and transverse abdominus can be fused as the Conjoint Tendon

Use interrupted non-absorbable 0 prolene

NB: mindful of the femoral vessels under inguinal liagment

Question 4

What are the principles of a shouldice repair?

Answer 4

Double breasted repair that incorporates the transversalise fascia, inguinal ligament and internal oblique

Open the tranversalis fascia the internal ring, careful not to injure in epigastric vessels that are medial to it. Should be able to see pre-peritoneal fat

Form two flaps of transversalis fascia

4 layer clousre with continous non-abdorable - 2/0 prolene. Start Pubic turbcle

Each layer takes of the tension from the prior layer

Question 5

What are the four layers of a shouldice repair?

Answer 5

1st Layer

lower flap of TF →upper flap

2nd Layer

Upper flap of TF → inguinal ligament

3rd Layer

TF/Internal oblique (I think the conjoint?) → inguinal ligament

4th Layer

Internal Oblique → inguinal ligament