2-LAYER REPAIR OF THE TRANSVERSALIS FASCIA IS SUFFICIENT FOR INGUINAL-HERNIA REPAIR

The Shouldice four-layer repair is considered to be the gold standard procedure for repair of inguinal hernia with low recurrence rates arou nd 1%. Tension-free two-layer repair of the transversalis fascia may b e all that is required to avoid recurrence. We compared the early recu rrence rate after two-layer repair of the transversalis fascia or the standard four-layer Shouldice technique in a randomised study of elect ive inguinal herniorrhaphy. In 48 patients (53 repairs) who had a two- layer transversalis fascia repair, there was one recurrence (2%) in th e first 12 months after operation, though there was one more recurrenc e within 36 months (total 4%). In 39 patients who had a four-layer Sho uldice repair (42 repairs), there was no recurrence at 12 months but a t 36 months two recurrences (5%) were found. We conclude that a two-la yer repair of the transversalis fascia is anatomically correct, physio logically sound and can provide equivalent results to the standard Sho uldice repair for inguinal hernia.