Inguinal hernia repair ranks among the most frequently performed surgical procedures globally. While mesh-based techniques, such as the Lichtenstein repair and laparoscopic methods, have become standard practice in numerous contexts, tissue-based repairs maintain significance for specific patient groups. The Shouldice repair is esteemed as the benchmark among non-mesh techniques, attributed to its low recurrence rates and favorable long-term outcomes when executed by skilled surgeons. This chapter explores the surgical principles, clinical outcomes, advantages, limitations, and contemporary relevance of the Shouldice technique. Evidence indicates that recurrence rates achieved in specialized centers are comparable to those associated with mesh-based repairs. Nevertheless, the operation's success is heavily reliant on the surgeon's expertise and patient selection. Current international guidelines continue to endorse the Shouldice repair as the preferred non-mesh option for selected primary inguinal hernias.