Shouldice Repair, a tissue-based repair, is the principal repair offered in the Shouldice Clinic. It was first described in 1945 by Dr. EE Shouldice. It is technically challenging, but when properly done, it has been reported to have a low recurrence rate of less than 2%. The two elements of the repair are the recreation of the internal ring using part of the cremaster and reinforcement of the posterior wall by repairing it in layers. It does not, however, deal with a femoral hernia and should only be used for the repair of a direct or an indirect inguinal hernia. The technical details of repair are discussed in this chapter.