studies have been able to validate the conclusion that patients have lower rates of hernia recurrence with the shouldice technique as compared to other non-mesh repair techniques. however this method frequently experiences longer procedure times and length of hospital stay. despite being the superior non-mesh technique, the shouldice method results much higher rates of hernia recurrence in patients when compared to repairs that utilize mesh.bassini technique, first suture. 1. aponeurosis musculi obliq. ext.; 2. musculus obliquus internus; 3. musculus transversalis; 4. fascia transversalis; 5. peritoneum; 6. ligamentum inguinale. bassini technique the bassini technique, described by edoardo bassini in the 1880s, was the first efficient inguinal hernia repair. in this technique, the conjoint tendon (formed by the distal ends of the transversus abdominis and internal oblique muscles) is approximated to the inguinal ligament and closed. other open non-mesh techniques the shouldice technique was itself an evolution of prior techniques that had greatly advanced the field of inguinal hernia surgery. such classic open non-mesh repairs include: mcvay technique halsted maloney darn plication darn desarda technique a 1–2 cm strip of the external oblique aponeurosis is stitched below to the inguinal ligament and above to the muscle arch without disturbing its continuity at either end. this gives immediate protection, so no restrictions on activities are required. the procedures results in very low recurrence and complication rates. laparoscopic repair port sites for inguinal hernia repair intraoperative view by tep operation. 1. genital ramus of genitofemoral nerve. 2. preperitoneal lipom and spermatic cord. there are two main methods of laparoscopic repair: transabdominal preperitoneal (tapp) and totally extra-peritoneal (tep) repair. when performed by a surgeon experienced in hernia repair, laparoscopic repair causes fewer complications than lichtenstein, particularly less chronic pain. however, if the surgeon is experienced in general laparoscopic surgery but not in the specific subject of laparoscopic hernia surgery, laparoscopic repair is not advised as it causes more recurrence risk than lichtenstein while also presenting risks of serious complications, as organ injury. all that said, many surgeons are shifting to using laparoscopic techniques as they require smaller incisions, and result in less bleeding, lower infection rates, faster recovery, shorter hospitalization periods, and reduced chronic pain. laparoscopic mesh surgery, as compared to open mesh surgery advantagesdisadvantages quicker recovery less pain during the first few days following the procedure fewer postoperative complications such as infections, bleeding and seromas lower risk of chronic pain needs a surgeon who is highly experienced in inguinal hernia repair (>200 operations/year) longer operation time increased recurrence of primary hernias if a surgeon is not experienced enough recurrence rates are identical when laparoscopy is performed by an experienced surgeon. when performed by a surgeon less experienced in inguinal hernia lap repair, recurrence is larger than after lichtenstein. robotic surgery robot assisted repair of inguinal hernias has demonstrated safety and efficacy in surgeries repairing inguinal hernias that present on both sides of the pubic bone (bilateral) as well as inguinal hernias that present on one side (unilateral). in comparing robot assisted repair of inguinal hernias to traditional laparoscopic techniques, robot assisted surgeries repairing inguinal hernias have longer operating times and can be more costly. however, measures of safety, complication rates, and readmission rates did not significantly differ between robot assisted repair and traditional laparoscopic repair. non-surgical management studies have demonstrated that men whose hernias cause little to no symptoms can safely continue to delay surgery until a time that is most convenient for patients and their healthcare team. research shows that the risk of inguinal hernia complications remains under 1% within the population. watchful waiting requires that patients maintain a close follow-up schedule with providers to monitor the course of their hernia for any changes in symptoms and can be safely offered for up to 2 years. patients who do elect watchful waiting eventually undergo repair within five years as 25% will experience a progression of symptoms such as worsening of pain. elective repair discussions should be revisited if patients begin to avoid aspects of their normal routine due to their hernia. after 1 year it is estimated that 16% of patients who initially opted for watchful waiting will eventually undergo surgery. furthermore, 54% and 72% will undergo repair at 5-year and 7.5-year marks respectively. the use of a truss is an additional non-surgical option for men. it resembles a jock-strap that utilizes a pad to exert pressure at the site of the hernia in order prevent excursion of the hernia sack. it has little evidence to support its routine use and has not been shown to prevent complications such as incarceration (bowel can no longer slide back into abdomen) or strangulation of bowel (constriction causing loss of blood supply). however some patients do report a soothing of symptoms when utilized. complications and prognosis inguinal hernia repair complications are unusual, and the procedure as a whole proves to be relatively safe for the majority of patients. risks inherent in almost all surgical procedures include: bleeding infection fluid collections damage to surrounding structures such as blood vessels, nerves, or the bladder urinary retention requiring a catheter risks that are specific to inguinal hernia repairs include such things as: recurrence of the hernia impairment of sexual activity, such as genital or ejaculatory pain in males, injury to the tube that conveys sperm from the testicle to the penis in males, bruising and swelling of the scrotum chronic regional pain (also known as post-herniorrhaphy inguinodynia, or chronic postoperative inguinal pain) post-herniorraphy pain syndrome post-herniorrhaphy inguinodynia is a condition where 10-12% of patients experience severe pain after inguinal hernia repair, due to a complex combination of different forms of pain signals. it can occur with any inguinal hernia repair technique, and if unresponsive to pain medications, further surgical intervention is often required. removal of the implanted mesh, in combination with bisection of regional nerves, is commonly performed to address such cases. there remains ongoing discussion amongst surgeons regarding the utility of planned resections of regional nerves as an attempt to prevent its occurrence. mortality rates mortality rates for non-urgent, elective procedures was demonstrated as 0.1%, and around 3% for procedures performed urgently. other than urgent repair, risk factors that were also associated with increased mortality included being female, requiring a femoral hernia repair, and older age. follow-up upon awakening from anesthesia, patients are monitored for their ability to drink fluids, produce urine, as well as their ability to walk after surgery. most patients are then able to return home once those conditions are met. it is not uncommon for patients to experience residual soreness for a couple of days after surgery. patients are encouraged to make strong efforts in getting up and walking around the day after surgery. most patients can resume their normal routine of daily living within the week such as driving, showering, light lifting, as well as sexual activity. long work absences are rarely necessary and length of sick days tend to be dictated by respective employment policies. in general, it is not recommended to administer antibiotics as prophylaxis after elective inguinal hernia repair. however, the rate of wound infection determines the appropriate use of the antibiotics. post-op development of any of the following should warrant timely reporting via phone: fever greater than 39c/101f progressive swelling of the surgical site severe pain recurring nausea or vomiting worsening redness around incisions drainage of pus from incisions difficulty or lack of producing urine new-onset shortness of breath prevention and screening most indirect inguinal hernias in the abdominal wall are not preventable. direct inguinal hernias may be prevented by maintaining a healthy weight, refraining from smoking, preventing straining during bowel movements, and maintaining proper lifting techniques when heavy lifting. there is no evidence that indicates physicians should routinely screen for asymptomatic inguinal hernias during patient visits.