Bassini's herniorrhaphy and Shouldice's herniorrhaphy are surgical techniques for hernia repair. Bassini's involves incising the transversalis fascia and dissecting preperitoneal fat to access the hernia. A triple-layer repair is performed to reinforce the floor. Shouldice's exposes the posterior inguinal floor and mobilizes fascial flaps. It employs a four-layer repair starting at the pubic tubercle and progressing laterally to reconstitute the internal ring and shelving edge with continuous sutures in overlapping layers.

1. Basics of operative surgery

6. Hernia Surgery: Herniotomy

11. Bassini’s Herniorrhaphy

12. Bassini’s
• the transversalis fascia is incised from the pubic tubercle to the
internal inguinal ring, thereby entering the preperitoneal space.
• Preperitoneal fat is bluntly dissected from the upper margin of the
posterior side of the transversalis fascia to permit adequate tissue
mobilization.
• A triple-layer repair is then performed to restore integrity to the
floor.
• The medial tissues, including the internal oblique muscle,
transversus abdominis muscle, and transversalis fascia, are fixed to
the shelving edge of the inguinal ligament and pubic periosteum
with interrupted sutures.
• The lateral border of the repair is the medial border of the internal
inguinal ring, which subsequently is reinforced by the repair.

14. Shouldice’s Herniorrhaphy

15. • Original descriptions of the Shouldice technique involved the use of a
stainless steel wire.
• With the posterior inguinal floor exposed, an incision in the transversalis
fascia is performed between the pubic tubercle and internal ring.
• Care is taken to avoid injury to any preperitoneal structures, and these are
bluntly dissected to mobilize the upper and lower fascial flaps.
• The first layer of repair begins at the pubic tubercle where the iliopubic
tract is sutured to the lateral edge of the rectus sheath, then progressing
laterally.
• The inferior flap of the transversalis fascia, which includes the iliopubic
tract, is sutured continuously to the posterior aspect of the superior flap of
the transversalis fascia until the internal ring is encountered. At this point,
the internal ring has been reconstituted.
• The suture is not tied here, but rather is continued back upon itself in the
medial direction. At the internal ring, the second layer is the
reapproximation of the superior edge of the transversalis fascia to the
inferior fascial margin and the shelving edge of the inguinal ligament. The
suture is then tied to the tail of the original stitch.
• A third suture is started at the tightened inguinal ring, joining the internal
oblique and transversus abdominis aponeuroses to external oblique
aponeurotic fibers just superficial to the inguinal ligament.
• This layer is continued to the pubic tubercle where it reverses upon itself to
create a fourth suture line, which is similar and superficial to the third layer.