no mesh surgery with continuous absorbable sutures

[Good intentions]

Here is another paper that cited the one you linked. It looks promising.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3321139/

One major problem in the hernia repair field is the huge investment that has been made in the mesh-based methods. Large corporations with large revenue streams based on selling mesh devices, and the fact that most educational institutions are supported by these medical device makers, training their new students in mesh implantation techniques, means that the incentive to learn non-mesh techniques like this have to come from the individual student. It is hard to imagine a young new doctor joining a practice and refusing to use the “state of the art” method. You’re new, you’re there to learn how things are done, you do what your mentor tells you to do. On top of that, the insurance companies decide what procedures are acceptable, for reimbursement.

Here’s an interesting article about the early years of a surgeon’s career. One sentence seems especially relevant. The “standard of care” is the phrase that you’ll see often when looking at why mesh is used. The device makers have managed to make mesh implantation the standard. Which just means that everybody is doing it, whether it’s the best or not. You can’t get in trouble if you’re doing what everyone else is doing.

“Case Selection. Young surgeons need to be constantly reminded to do what is safe, proven, simple, and accepted as the community standard of care. Those heroic procedures done as a resident will get you in trouble more often than not outside a tertiary care center.”

https://jamanetwork.com/journals/jamasurgery/fullarticle/508661

[kaspa]

After searching through literature I found that they cut cremaster to inspect canal’s floor, which is a frequent seat of second hernias (2/3 of missed hernias).

In Shouldice, “cremasteric tissue is divided leaving the distal end long enough to support the testis, thus avoiding a dependent testis and the proximal stump reasonably short to be incorporated to a newly formed internal ring.”