Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT

Abstract

This study compared the short-term outcomes of the non-mesh (Desarda) and mesh (Lichtenstein) methods of hernia repair among Black African patients, with regard to acute postoperative pain, day of return to normal gait, operative time and complications. A total of 101 participants (51 in the Lichtenstein arm and 50 in the Desarda arm) were enrolled into this single centre double-blind randomised controlled trial. The outcome measures were evaluated at 1-2 h, 3, 7 and 14 days. The power of the study was set at 80%, CI at 95% and a two-sided P < 0.05 was considered statistically significant. There was no significant difference in the mean pain score (based on Visual Analogue Scale 0-10) between the study arms [3rd postoperative day (POD): 3.33 ± 1.75 for Lichtenstein and 2.73 ± 1.64 for Desarda, Effect size (CI): 0.59 (-0.088-1.272) and the scores on the 7th POD were 1.31 ± 1.19 for Lichtenstein and 1.31 ± 1.34 for Desarda, effect size (CI): 0.00 (-0.509-0.509)]. No difference was observed in regard to mean day of resumption of normal gait [2.44 ± 1.62 for Lichtenstein and 2.06 ± 1.13 for Desarda, effect size (CI): 0.08 (-0.030-0.193)]. A significant difference was recorded in regard to operative time, with the Desarda repair markedly shorter in duration [15.9 ± 3.52 min for Lichtenstein repair and 10.02 ± 2.93 min for Desarda's repair, effect size (CI): 5.92 (4.62-7.20), P = 0.0001]. Complication rates were similar in the two study arms. The results of the study showed that the effectiveness of the Desarda technique with respect to influencing the early clinical outcomes of hernia repair is similar to that of the Lichtenstein method. However, the operator in this study showed that the Desarda repair requires significantly shorter operative time.