Two-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 around 1%. Tension-free two-layer repair of the transversalis fascia may be all that is required to avoid recurrence. We compared the early recurrence rate after two-layer repair of the transversalis fascia or the standard four-layer Shouldice technique in a randomised study of elective inguinal herniorrhaphy. In 48 patients (53 repairs) who had a two-layer transversalis fascia repair, there was one recurrence (2%) in the first 12 months after operation, though there was one more recurrence within 36 months (total 4%). In 39 patients who had a four-layer Shouldice repair (42 repairs), there was no recurrence at 12 months but at 36 months two recurrences (5%) were found. We conclude that a two-layer repair of the transversalis fascia is anatomically correct, physiologically sound and can provide equivalent results to the standard Shouldice repair for inguinal hernia.