Postoperative Outcomes of the Desarda Technique Versus Lichtenstein Mesh Repair for Inguinal Hernias: A Systematic Review and Meta-Analysis.

Inguinal hernias represent a prevalent surgical condition worldwide and constitute a significant proportion of elective general surgical procedures. While the Lichtenstein mesh repair has become the standard technique due to its tension-free approach, it is associated with several mesh-related complications, including chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. To overcome these limitations, the Desarda technique was developed as a tissue-based, mesh-free alternative that reinforces the posterior wall of the inguinal canal using a strip of the external oblique aponeurosis. This systematic review compares postoperative complications between the Lichtenstein mesh repair and Desarda techniques to inform best practices in inguinal hernia repair. This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was performed across PubMed, Cochrane Library, Excerpta Medica database (EMBASE), Emcare, Medical Literature Analysis and Retrieval System Online (MEDLINE), and Ovid, without language or date restrictions. Randomized controlled trials (RCTs) comparing Desarda and Lichtenstein mesh repair for primary inguinal hernia in adults were included. Data on postoperative complications were independently extracted by two reviewers. Risk of bias was assessed using the Risk of Bias 2 (ROB 2) tool (The Cochrane Collaboration, London, United Kingdom). Statistical analysis was performed using RevMan 5.4 (The Cochrane Collaboration, 2020), with risk ratios (RR) and 95% confidence intervals (CI) calculated for binary outcomes. Heterogeneity was assessed using the chi-square and I² statistics. A total of 23 RCTs were included, comprising 2,425 patients, 1,201 of whom underwent the Desarda repair and 1,233 who underwent Lichtenstein mesh repair. The Desarda technique was associated with significantly lower rates of scrotal edema (RR = 0.52, 95% CI: 0.34-0.78, p = 0.002), seroma formation (RR = 0.68, 95% CI: 0.47-0.99, p = 0.04), foreign body sensation (RR = 0.61, 95% CI: 0.42-0.88, p = 0.009), and chronic postoperative pain (RR = 0.26, 95% CI: 0.15-0.45, p < 0.00001). While the Desarda group also showed lower rates of recurrence, wound infection, wound hematoma, and loss of sensation, these differences were not statistically significant and should be interpreted with caution. The findings suggest that the Desarda technique may be preferable to the Lichtenstein mesh repair for primary inguinal hernia, as it is associated with significantly lower rates of chronic postoperative pain, seroma, scrotal edema, and foreign body sensation. Although other complications, such as loss of sensation, recurrence, wound infection, and hematoma, were also less frequent with the Desarda technique, these differences were not statistically significant. Overall, the outcomes were largely comparable.