Desarda versus Lichtenstein inguinal hernia repair: A meta-analysis of randomized controlled trials.

BACKGROUND

The Lichtenstein technique is the gold standard for adult open inguinal hernia repair with mesh. The Desarda technique emerged in 2001 as a novel, promising non-mesh technique that has demonstrated low recurrence and postoperative complications.

METHODS

We searched MEDLINE, the Cochrane Central Register of Clinical Trials, and Embase for randomized controlled trials (RCT) published until April 2024. Odds ratios (ORs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Heterogeneity was assessed using Cochran's Q test and I2 statistics, with p-values <0.10 and I2>25% considered significant. Statistical analysis was performed using the R software, version 4.1.2.

RESULTS

Eighteen RCTs comprising 1756 patients were included, of whom 861 (49%) were submitted to Desarda and 895 (51%) were submitted to Lichtenstein. Desarda was associated with lower seroma rates (OR 0.55; 95% CI 0.35-0.89; and p = 0.014), less operative time (MD -8.6 min; 95% CI -14.5 to -2.8; and p < 0.01), lower postoperative pain on day one (MD -1.3 VAS score; 95% CI -2.3 to -0.3; p < 0.01) or chronic pain (OR 0.32; 95% CI 0.12-0.88; and p = 0.028), and faster return-to-work activities (MD -2.1 days; 95% CI -3.7 to -0.6; and p < 0.01). The recurrence rate was 1.4% for Desarda versus 2.1% for Lichtenstein, with no statistical difference between techniques.

CONCLUSION

In this meta-analysis, Desarda significantly decreases seroma operative time, postoperative pain on day 1, chronic pain, and return-to-work activities.