The shouldice repair is a contiuous two layer reconstruction of normal inguinal anatomy, reattaching falx and transversalis cephalad to iliopubic tract and inguinal ligament caudally. This reestablishes the flexible shock absorber function of the inguinal ligament. A 2-0 prolene stitch is anchored in the fascia over the pubic tubercle (not down to periosteum which hurts) and tied. The reflected edge of the falx is sutured to iliopubic tract and inguinal ligament up to the deep ring. The suture is then reversed, suturing the free edge of the cephalad flap to iliopubic tract and inguinal ligament. These bites are taken between the bites of the first row. The object is to recreate a 1cm deep inguinal ring.
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