A Randomised Controlled Trial Comparing Modified Bassini Repair and No-Mesh Desarda Hernia Repair where Prosthetic Mesh is Unavailable

Background: The gold standard for hernia repair has remained a tension free, permanent, simple to perform and safe repair. The absolute achievement of this has remained elusive. For a long time, the Mesh hernioplasty was considered the closest to this standard and was adopted by the European Hernia Society as the procedure of choice. The prosthetic Mesh, mostly polypropylene mesh, has many inherent drawbacks. It is costly, mostly non-available in poor countries, carries the risk of mesh displacement and hernia repair failure, and is associated with high risk of mesh infection that will require subsequent removal. The Desarda No-mesh, biological tissue repair obviates the noted drawbacks associated with the mesh, and in addition, provides a strong, mobile and physiologically dynamic posterior inguinal wall that effectively limits repair failure. This can be a good alternative to the Modified Bassini Repair that is fraught with high recurrence.

Objectives: To compare the short and medium term outcomes between the Modified Bassini and the No-mesh Desarda hernia repair.

Methods: A total of 50 adult male and female patients with primary inguinal hernias were randomly allocated intraoperatively to undergo Desarda No-mesh or Modified Bassini inguinal hernia repair. Each patient is allocated to either of the procedures through balloting.

Results: From our evaluation of the short-term and medium-term outcomes, such as surgery duration, immediate post-operative pain, ability to achieve normal gait, early return to work and early recurrence; Desarda technique is effective and safe, with the least post-operative complications compared to Modified Bassini Inguinal Hernia repair.

Conclusion:  Desarda repair is easy to perform and has been shown to take shorter operative time. Also, it is associated with less post-operative pain and there is no need of mesh. It is therefore cost effective and is similar to Lichtenstein method in terms of early recurrence rate. Desarda hernia repair can be a good substitute to Lichtenstein repair and should be recommended for younger patients because of the proposed lesser risk for post-operative sexual dysfunction and subfertility.

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The authors declare no conflict of interest.

Not applicable

The datasets used in this study are openly available at [repository link] and the source code is available on GitHub at [GitHub link].

This work did not receive any external funding.