It is important to note that herniotomy is not performed in direct inguinal hernia instead the sac is inverted here.
Herniotomy+ with reconstruction of posterior wall of inguinal canal by approximating conjoint muscle and tendon to recurved edge of inguinal ligament with non-absorbable suture such as silk, nylon or prolene. This is known as bassini's repair. Silk is usually avoided as if it becomes infected it will cause sinuses.
Suture must be done with out tension as this will lead to cutting of the muscle or ligaments from their sutures. To avoid the tension one may add tanner's slide operation where a curved release incision is made in anterior rectus sheath above the conjoint tendon so that the lateral leaf of the incision at once retracts down and makes the tense conjoint tendon loose.
IV. Willy - Andrews modifications: Upper flap of external oblique aponeurosis is sutured down to inguinal ligament as an added posterior layer and lower flap is brought over the cord and sutured to upper flap, so that cord was sandwiched between two layers of external oblique.
IV. Upper and lower flap of transversais facia are sutured in double bresting manner by using non-absorbable sutures like 34-gauge stainless steel wire, poyamide or polypropylene. This is the first layer of shouldice repair.
Herniotomy+ reinforcement of posterio ...