Inguinal hernia surgery according to Shouldice

The inguinal hernia surgery in the Shouldice technique (named after the surgeon Edward Earle Shouldice ) is a conventional (i.e. not minimally invasive ) surgical method that has been in use since the late 1980s and replaced the Bassini method . The operation can be performed under local anesthesia .

The principle of the operation is to reduce (reduce) the contents of the hernia and to remove the indirect hernial sac. The direct hernial sac is also reduced. This is followed by a reconstruction of the posterior wall of the inguinal canal that corresponds to the anatomy . The transversalis fascia is doubled, narrowing the indirect hernia and closing the direct hernia.

indication

In principle, this surgical procedure can be used for any inguinal hernia of any patient age. In practice, however, it is almost only used in adolescents and young adults and has been largely superseded by modern procedures with mesh implantation ( Lichtenstein operation , TAPP ). It is the surgical procedure of choice if the patient rejects foreign material or there is a contraindication to foreign material (e.g. allergy ).

method

The transversalis fascia (connective tissue covering the skeletal muscles between the parietal peritoneum and the abdominal muscles ) is split and then sutured again with doubling. The posterior wall of the inguinal canal now consists of two layers of the transversalis fascia. In a first row of sutures, the caudal lip of the transversal fascia and the posterior surface of the transversus abdominis muscle (runs across the body axis) are sutured where it forms an aponeurotic portion , the so-called arcus tendineus . The second row is placed in such a way that the cranial lip of the transversalis fascia is pexed to the insertion of the inguinal ligament . Often one is content with these two steps of doubling the transversalis fascia. The original technique according to Shouldice sews the transversus abdominis muscle to the inguinal ligament in a 3rd row, and the internal obliquus abdominis muscle (runs obliquely to the body axis) to the inguinal ligament in a 4th row .

Summary

After doubling the fascia transversalis (connective tissue covering the skeletal muscles between the abdominal cavity wall and the abdominal muscles), the transverse and internal oblique muscles are attached to the inguinal ligament by means of a continuous suture. The external aponeurosis (external tendon plate) is closed over the inguinal ligament.

Web links

G. Arlt, V. Schumpelick: The inguinal hernia operation according to Shouldice - current technology and results. In: Zentralblatt für Chirurgie. 127, pp. 565-569, doi : 10.1055 / s-2002-32844 .
E-learning course on inguinal hernias (Charité Berlin)

source

Siewert, Chirurgie , 6th edition