Inguinal hernia is one of the most common surgical conditions worldwide and constitutes a frequent indication for elective general surgical intervention. The open tension‑free mesh repair using the technique described by Alexander Lichtenstein — commonly called Lichtenstein mesh repair is widely accepted as the “gold standard” for adult open inguinal hernia repair owing to its low recurrence rates and reproducible outcomes [1]. However, mesh-based repairs are associated with certain disadvantages, including foreign‑body sensation, chronic groin pain (inguinodynia), mesh infection, testicular complications, and increased cost — concerns that are particularly significant in low-resource settings or among patients with comorbidities [2]. These drawbacks have encouraged surgeons to revisit tissue-based repair techniques that avoid prosthetic implants. Among them, Desarda repair (first described in 2001) uses a strip of the patient’s own external oblique aponeurosis to reinforce the posterior wall of the inguinal canal, offering a mesh-free, biologically compatible alternative [3].Over the past two decades, multiple randomized controlled trials and cohort studies have compared Desarda repair with Lichtenstein mesh hernioplasty. In one randomized trial of 168 patients (85 undergoing Desarda and 83 undergoing Lichtenstein), follow-up over two years revealed a single recurrence in each group (P = 0.99), and comparable rates of chronic groin pain (5.6% vs 4.2%, P = 0.68). Importantly, Desarda repair demonstrated significantly shorter operating time and earlier return to normal activity [4]. Similarly, a larger randomized comparative study including 164 patients (80 Desarda vs 84 Lichtenstein) reported no recurrences over two years; moreover, Desarda repair was associated with shorter operative time, reduced early postoperative pain, less foreign-body sensation, lower cost, and faster return to work [5]. A recent meta-analysis of 18 randomized controlled trials with a total of 1,756 patients (861 Desarda, 895 Lichtenstein) confirmed these findings: compared to mesh repair, Desarda significantly reduced seroma formation, operative time (mean difference –8.6 min), early postoperative pain, chronic pain (OR 0.32), and hastened return to work by approximately 2.1 days — with no statistically significant difference in recurrence rates (1.4% Desarda vs 2.1% Lichtenstein) [6].Despite accumulating evidence supporting Desarda repair, the technique has not yet replaced mesh repair universally. The study aims to compare the outcomes of Lichtenstein mesh repair and Desarda non-mesh repair in patients with inguinal hernia, focusing on operative time, postoperative complications, recurrence rates, and chronic pain, to determine the more effective and safe surgical approach.

Type of Study: A comparative study Place of Study: Department of general surgery nil ratan sircar medical college & hospital Study Duration: 1 year (From 1st February 2023 to 31st January 2024.) Sample Size: 100 Inguinal hernia patients Inclusion Criteria: • Patients aged 18–70 years with primary unilateral or bilateral inguinal hernia. • Patients fit for elective surgery under general or regional anesthesia. • Patients providing informed consent. Exclusion Criteria: • Recurrent or complicated hernias (incarcerated/strangulated). • Patients with coagulopathy or uncontrolled systemic illness. • History of previous lower abdominal surgery affecting the inguinal region. • Immunocompromised patients or those unwilling to participate. Study Variables: • Age • Gender • Body Mass Index (BMI) • Side of hernia • Type of hernia • Duration of symptoms Statistical Analysis: Data were entered into Excel and subsequently analyzed using SPSS and GraphPad Prism. Continuous variables were summarized as means with standard deviations, while categorical variables were presented as counts and percentages. Comparisons between independent groups were performed using two-sample t-tests, and paired t-tests were applied for correlated (paired) data. Categorical data were compared using chi-square tests, with Fisher’s exact test applied when expected cell counts were small. A p-value of ≤ 0.05 was considered statistically significant.

Table 1 Baseline demographics Variable Lichtenstein Desarda p-value Age (years) 45.2 ± 12.1 44.0 ± 11.8 0.65 Male 49 (98.0%) 49 (98.0%) 1 Unilateral hernia 46 (92.0%) 47 (94.0%) 0.688 Table 2 Operative details Variable Lichtenstein Desarda p-value Operative time (min) 45.0 ± 10.0 50.0 ± 12.0 0.02 Intraoperative complications 1 (2.0%) 2 (4.0%) 0.558 Table 3 Early postoperative pain (objective) Variable Lichtenstein Desarda p-value VAS at 24 h (0–10) 3.2 ± 1.1 2.8 ± 1.0 0.04 Analgesic doses first 48 h 3.6 ± 1.2 3.1 ± 1.0 0.035 Table 4 Early wound complications (within 30 days) Complication Lichtenstein Desarda p-value Seroma 6 (12.0%) 3 (6.0%) 0.294 Wound infection 2 (4.0%) 1 (2.0%) 0.564 Hematoma requiring intervention 1 (2.0%) 1 (2.0%) 1 Table 5 Chronic groin pain at 6 months and Recurrence and follow-up (1 year) Outcome Lichtenstein Desarda p-value Any chronic pain (≥3 months) 8 (16.0%) 3 (6.0%) 0.089 Moderate/severe chronic pain 3 (6.0%) 1 (2.0%) 0.307 Followed to 12 months 48 (96.0%) 47 (94.0%) 0.645 Recurrence at 1 year 1 (2.0%) 2 (4.0%) 0.558 Figure 1 Chronic groin pain at 6 months and Recurrence and follow-up (1 year) In our study, the demographic characteristics were comparable between the two groups. The Lichtenstein group (n = 50) had a mean age of 45.2 ± 12.1 years, while the Desarda group (n = 50) had a mean age of 44.0 ± 11.8 years, with no statistically significant difference (p = 0.65). Male patients constituted 49 (98%) in each group (p = 1). Unilateral hernia was present in 46 (92%) patients in the Lichtenstein group and 47 (94%) patients in the Desarda group, with no statistically significant difference (p = 0.688). In our study, the mean operative time was significantly shorter in the Lichtenstein group (45.0 ± 10.0 minutes) compared to the Desarda group (50.0 ± 12.0 minutes), and this difference was statistically significant (p = 0.02). Intraoperative complications were infrequent in both groups, occurring in 1 (2.0%) patient in the Lichtenstein group and 2 (4.0%) patients in the Desarda group, with no statistically significant difference between the groups (p = 0.558). In our study, postoperative pain assessed by VAS at 24 hours was significantly higher in the Lichtenstein group (3.2 ± 1.1) compared to the Desarda group (2.8 ± 1.0), with the difference being statistically significant (p = 0.04). Similarly, the mean number of analgesic doses required during the first 48 hours was higher in the Lichtenstein group (3.6 ± 1.2) than in the Desarda group (3.1 ± 1.0), and this difference was statistically significant (p = 0.035). In our study, postoperative complications were comparable between the two groups. Seroma formation was observed in 6 (12.0%) patients in the Lichtenstein group and 3 (6.0%) patients in the Desarda group, with no statistically significant difference (p = 0.294). Wound infection occurred in 2 (4.0%) patients in the Lichtenstein group and 1 (2.0%) patient in the Desarda group (p = 0.564). Hematoma requiring intervention was noted in 1 (2.0%) patient in each group, showing no significant difference (p = 1). n our study, chronic pain persisting for ≥3 months was more frequently observed in the Lichtenstein group, with 8 (16.0%) patients affected, compared to 3 (6.0%) patients in the Desarda group; however, this difference did not reach statistical significance (p = 0.089). Moderate to severe chronic pain was noted in 3 (6.0%) patients following Lichtenstein repair and in 1 (2.0%) patient following Desarda repair, with no statistically significant difference between the groups (p = 0.307). In our study, follow-up at 12 months was achieved in 48 (96.0%) patients in the Lichtenstein group and 47 (94.0%) patients in the Desarda group, with no statistically significant difference between the groups (p = 0.645). Recurrence at one year was low in both groups, occurring in 1 (2.0%) patient following Lichtenstein repair and 2 (4.0%) patients following Desarda repair, and this difference was not statistically significant (p = 0.558).

We observed that both groups were demographically comparable, with similar mean age (Lichtenstein: 45.2 ± 12.1 years vs Desarda: 44.0 ± 11.8 years), male predominance (98% in each), and unilateral hernia distribution (92% vs 94%). We observed that operative time was significantly shorter with Lichtenstein repair (45.0 ± 10.0 minutes) compared to Desarda repair (50.0 ± 12.0 minutes). We observed that early postoperative pain was higher in the Lichtenstein group, with a greater mean VAS score at 24 hours (3.2 ± 1.1 vs 2.8 ± 1.0) and increased analgesic requirement in the first 48 hours (3.6 ± 1.2 vs 3.1 ± 1.0). We observed that postoperative complications such as seroma (12.0% vs 6.0%), wound infection (4.0% vs 2.0%), and hematoma (2.0% in both) were numerically higher in the Lichtenstein group, although these differences were not statistically significant. We observed that chronic groin pain persisting for ≥3 months was more frequent following Lichtenstein repair (16.0%) than Desarda repair (6.0%), with moderate to severe pain also higher in the Lichtenstein group (6.0% vs 2.0%), though without statistical significance. We observed that one-year follow-up rates were comparable (96.0% vs 94.0%) and recurrence rates remained low and similar between the two techniques (2.0% vs 4.0%), suggesting comparable short-term durability of both procedures. In similar study by Desarda MP (2001) first described his non-mesh repair and reported demographic comparability between groups, shorter operative time with Lichtenstein repair, but significantly lower early postoperative pain and reduced foreign-body–related complications following Desarda repair [7]. Jain SK et al. (2012), in an Indian randomized study, similarly observed equivalent age and sex distribution, marginally longer operative time for Desarda repair, higher early postoperative pain scores in the Lichtenstein group, and a greater need for postoperative analgesics, while recurrence rates at one year were low and comparable between the two techniques [8]. In a randomized controlled trial by Mitura K and Romańczuk M (2012), mesh repair was associated with higher incidence of early postoperative discomfort and chronic groin pain, whereas Desarda repair showed less chronic pain with no statistically significant difference in recurrence, supporting the trend seen in our study [9]. Youssef T et al. (2015) also reported higher rates of seroma and wound-related complications following Lichtenstein repair, though most differences were not statistically significant, and both techniques demonstrated similar short-term recurrence rates [10]. Likewise, Rodríguez P et al. (2013) found that while Lichtenstein repair had marginally shorter operative time, Desarda repair resulted in lower chronic groin pain without compromising recurrence rates at one-year follow-up [11]. Overall, comparison with existing literature suggests that both techniques offer comparable durability, while Desarda repair may provide advantages in terms of postoperative pain and chronic groin discomfort.

We concluded that both Desarda non-mesh repair and Lichtenstein mesh repair are safe and successful methods for repairing inguinal hernias, with similar hernia features and demographic distribution. Lichtenstein repair was linked to statistically higher rates of seroma, wound infection, and hematoma as well as higher early postoperative discomfort and the need for more analgesics. Although not statistically significant, the frequency of chronic groin discomfort at ≥3 months was higher after Lichtenstein repair. A one-year follow-up showed that the two procedures' overall durability and recurrence rates were comparable. These results imply that Desarda repair may be linked to less postoperative discomfort, while Lichtenstein repair offers slightly quicker surgery. Both methods are therefore feasible choices, with surgeon preference and patient-specific considerations guiding the decision.

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