One particular element to the Shouldice repair is that of division of the transversalis fascia. Its purpose is to facilitate a later double-breasting of this layer to provide reinforcement.
After exposure of the cord, it is elevated to reveal the fascia condensed onto its surface at the deep ring. Using sharp dissection, a plane is developed between the cord and the ring. When the medial border of the ring becomes demarcated, it is gripped by a haemostat and lifted anteriorly.
Sharp scissors are passed in the plane deep to transversalis fascia but superficial to preperitoneal fat from the medial border of the deep ring along the line of the incision. This extends to the pubic tubercle along the whole length of the canal.
Hence, two flaps of transversalis fascia are created, superior and inferior. These are bluntly dissected away from deeper preperitoneal fat ensuring careful haemostasis on route.
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