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Open darn repair vs open mesh repair of inguinal hernia: a systematic review and meta-analysis of randomised and non-randomised studies

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Abstract

Objectives

To compare the outcomes of open darn repair vs open mesh repair in patients undergoing inguinal hernia repair.

Methods

We performed a systematic review and conducted a search of electronic information sources to identify all observational studies and randomised controlled trials (RCTs) investigating outcomes of open darn repair vs open mesh repair for inguinal hernias. Hernia recurrence was considered as the primary outcome measure. The secondary outcome measures included surgical site infection (SSI), haematoma, seroma, neuralgia, urinary retention, length of hospital stay, time to return to normal activities or work, testicular atrophy, operative time and chronic pain. Random or fixed effects modelling was applied to calculate pooled outcome data.

Results

Six RCTs, enrolling 1480 patients with 1485 hernias, and 4 observational studies, enrolling 1564 patients with 1641 hernias, were included. Meta-analysis of RCTs showed no significant difference in terms of recurrence (RD 0.00, 95% CI − 0.01 to 0.01, P = 0.86), SSI (OR 0.83, 95% CI 0.46–1.49, P = 0.52), haematoma (OR 1.21, 95% CI 0.62–2.38, P = 0.57), seroma (OR 0.83, 95% CI 0.42–1.65, P = 0.60), neuralgia (OR 1.05, 95% CI 0.29–3.73, P = 0.94), urinary retention (OR 1.44, 95% CI 0.64–3.21, P = 0.38), length of hospital stay (MD 0.09, 95% CI − 0.28 to 0.46, P = 0.63), time to return to normal activities or work (MD 0.88, 95% CI − 0.90 to 2.66, P = 0.33), testicular atrophy (RD 0.00, 95% CI − 0.02 to 0.02, P = 1.00), and operative time (MD 2.69, 95% CI − 1.75 to 7.14, P = 0.62) between the darn repair and mesh repair groups. Meta-analysis of observational studies also showed no significant difference in terms of recurrence (RD 0.00, 95% CI − 0.02 to 0.02, P = 0.99), SSI (OR 0.47, 95% CI 0.14–1.62, P = 0.23), haematoma (OR 1.07, 95% CI 0.45–2.55, P = 0.89), seroma (OR 0.12, 95% CI 0.01–2.27, P = 0.16), neuralgia (OR 0.25, 95% CI 0.05–1.21, P = 0.08), urinary retention (OR 1.53, 95% CI 0.20–11.96, P = 0.69), time to return to normal activities or work (MD 2.13, 95% CI − 2.18 to 6.44, P = 0.33), testicular atrophy (RD − 0.01, 95% CI − 0.02 to 0.01, P = 0.49), and operative time (MD − 4.76, 95% CI − 13.23 to 3.71, P = 0.27) between the two groups. The evidence was inconclusive for chronic pain. The quality of available evidence was moderate.

Conclusions

Our results suggest that open darn repair is comparable with open mesh repair for inguinal hernias. Considering that consequences of mesh complications in inguinal hernia repair, albeit rare, can be significant, open darn repair provides an equally credible alternative to open mesh repair for inguinal hernias. Further studies are required to investigate patient-reported outcomes and to elicit a superior non-mesh technique.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Author information

Authors and Affiliations

  1. Department of General Surgery, Pinderfields General Hospital, Wakefield, UK

    D. A. Finch

  2. Department of General Surgery, Royal Bolton Hospital, Bolton, UK

    V. A. Misra

  3. Department of General Surgery, North Manchester General Hospital, Manchester, UK

    S. Hajibandeh

Authors
  1. D. A. Finch
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  2. V. A. Misra
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  3. S. Hajibandeh
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Contributions

Conception and design: SH. Data collection: DAF, VAM, and SH. Analysis and interpretation: DAF and SH. Writing the article: DAF and SH. Critical revision of the article: DAF and SH. Final approval of the article: DAF, VAM and SH. Statistical analysis: SH.

Corresponding author

Correspondence to D. A. Finch.

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Conflict of interest

DAF declares no conflict of interest. VAM declares no conflict of interest. SH declares no conflict of interest.

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This was deemed to not be required.

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This article does not contain any direct involvement of human participants as it is comprised of data from papers already published.

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Appendix

Appendix

Search no.

Search strategya

#1

darn: TI,AB,KW

#2

darning: TI,AB,KW

#3

modified near2 darn*: TI,AB,KW

#4

#1 OR #2 OR #3

#5

mesh: TI,AB,KW

#6

lichtenstein: TI,AB,KW

#7

#5 OR #6

#8

MeSH descriptor: [inguinal hernia] explode all trees

#9

inguinal hernia: TI,AB,KW

#10

#8 OR #9

#11

#4 AND #7 AND #10

  1. aThis search strategy was adopted for following databases: MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL)

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Finch, D.A., Misra, V.A. & Hajibandeh, S. Open darn repair vs open mesh repair of inguinal hernia: a systematic review and meta-analysis of randomised and non-randomised studies. Hernia 23, 523–539 (2019). https://doi.org/10.1007/s10029-019-01892-1

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  • DOI: https://doi.org/10.1007/s10029-019-01892-1

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