Bassini and should've repair
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inguinal hernia AND Shouldice
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HerniaSurge international guidelines groin hernia management Shouldice repair Bassini
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Bassini repair vs Shouldice repair
Both are open, non-mesh tissue repairs for an inguinal hernia. They strengthen the posterior wall of the inguinal canal after dealing with the hernial sac.
| Feature | Bassini repair | Shouldice repair |
|---|---|---|
| Principle | Approximate the conjoint tendon to the inguinal ligament | Multilayer reconstruction of the transversalis fascia and posterior wall |
| Main repair | Sutures from conjoint tendon / transversus abdominis aponeurosis to inguinal ligament | Transversalis fascia is opened, overlapped (double-breasted), then reinforced with further continuous layers |
| Number of layers | Essentially single-layer posterior-wall repair | Classically four-layer repair |
| Tension | More tension on tissues | Tension distributed across several layers |
| Recurrence | Generally higher than expert Shouldice repair | Lower than other non-mesh repairs when performed by experienced surgeons |
| Technical demand | Relatively simpler | More technically demanding and operator-dependent |
Bassini repair
After herniotomy, the conjoint tendon is sutured to the inguinal ligament from the pubic tubercle toward the deep inguinal ring. This reconstructs and reinforces the posterior wall of the inguinal canal.
Key point: It is a historical foundation for tissue repairs but can place tissue under tension, especially in a large direct hernia.
Shouldice repair
This is a refinement of Bassini repair:
- Incise the transversalis fascia from the deep ring to the pubic tubercle.
- Overlap the fascial flaps to form a double-breasted first two layers.
- Add further reinforcing layers by suturing the transversus abdominis/internal oblique region to the inguinal ligament.
- Close the external oblique over the cord.
Key point: It distributes tension over several suture lines, which explains its better results in specialist hands.
Present-day relevance
For most adults, modern groin-hernia guidelines generally favor a mesh repair when appropriate, using either an open Lichtenstein approach or laparo-endoscopic repair such as TEP/TAPP. If a non-mesh repair is required or chosen, Shouldice is the preferred tissue repair, rather than Bassini, provided the surgeon has sufficient expertise. The updated HerniaSurge guideline reports lower recurrence with Shouldice than with other suture repairs, but the technique has a learning curve.
One-line exam answer:
Bassini repair is a single-layer approximation of conjoint tendon to inguinal ligament; Shouldice repair is its multilayer, double-breasting modification of transversalis fascia with lower recurrence in experienced hands.
Bassini repair is a single-layer approximation of conjoint tendon to inguinal ligament; Shouldice repair is its multilayer, double-breasting modification of transversalis fascia with lower recurrence in experienced hands.
Incision for hernia surgery
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inguinal hernia AND incision
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open inguinal hernia repair skin incision surgical technique guideline
For an open inguinal hernia repair such as Bassini or Shouldice:
- Make a 5-6 cm oblique skin incision in the groin.
- It is placed parallel and just superior to the medial half of the inguinal ligament, centered over the superficial inguinal ring.
- Extend from near the pubic tubercle medially toward the deep inguinal ring laterally.
- Divide subcutaneous tissue and Scarpa fascia.
- Incise the external oblique aponeurosis in line with its fibres, opening the superficial ring to expose the spermatic cord.
For a large inguinoscrotal or obstructed/strangulated hernia, the incision may need extension. Care is needed to identify and preserve the ilioinguinal nerve. Bailey and Love describes the incision as one made over the inguinal canal, followed by division of Scarpa fascia to expose the external oblique aponeurosis.
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