Hernia Repair Research Articles

Limited or Lasting: Is Preoperative Weight Loss as Part of Prehabilitation Maintained after Open Ventral Hernia Repair?

Obesity is directly correlated with wound complications and recurrence following open ventral hernia repair (OVHR). Preoperative weight loss (WL) mitigates these risks, improves overall health, and reduces intraabdominal volume. For patients successful in losing weight, it is unclear whether this WL is maintained. A prospective, single-institution hernia database was queried for patients with a BMI≥25kg/m2, who were requested to lose weight and lost a minimum of 10lbs preoperatively. Patients' weight was examined at two timepoints: postoperative appointment 6months-1year and their most recent documented weight. Of 256 included patients, average age was 58.2±11.2 years, 30.5% were diabetic, and 67.9% were ASA class III-IV. At initial consultation, average BMI was 38.2±6.6kg/m2 and 34.0±5.8kg/m2 at time of surgery. Average preoperative WL was 26.1±17.1lbs (10-120lbs) over 10.0±13.6 months.At the first postoperative timepoint, average BMI was 33.6±5.8kg/m2, and patients lost an additional 1.8±16.2lbs over 8.4±9.0 months after surgery. At 42.0±36.2 months postoperatively, patients gained an average of 2.0±27.1lbs, for a net WL of 24.0±31.9lbs from consultation.After surgery, 47.3% of patients continued WL for an additional 18.6±26.4lbs (total net WL: 44.7lbs) and decreased BMI by 2.5±3.6kg/m2; 0.8% maintained their same weight; 22.3% gained back less than half of preoperative WL, totaling 70.3% of patients with long-term optimization. Prehabilitation-induced WL averaged 26lbs. With 3.5years follow-up, patients weighed an average of 24lbs less than their initial consult weight. Nearly half of patients continued WL postoperatively, and more than 70% maintained at least half of their WL, demonstrating longevity to preoperative optimization.

A Systematic Review of Open, Laparoscopic, and Robotic Inguinal Hernia Repair: Management of Inguinal Hernias in the 21st Century

Background: In the 21st century, the management of groin hernias (GHs) has evolved from watchful waiting (WW) to robotic hernia repair (RHR). The present study interrogates the status of robotics in the context of current repairs and provides one author’s perspectives. Methods: A systematic review was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines for studies comparing open (OHR) to robotic hernia repair (RHR); RHR to laparoscopic hernia repair (LHR); or OHR vs. LHR vs. RHR. The historical context was extracted from previous reviews. Results: Fifty-four studies were included in the analysis. Three techniques have withstood the test of time: OHR (tissue and mesh repairs), laparo-endoscopic (TEP and TAPP), and RHR. The literature indicates that RHR is safe and effective for the management of groin hernias. Operative times and costs remain a concern when using this technique. While the number of overall complications with RHR is similar to OHR, in a minority of cases, complications are more consequential with the robotic platform. Conclusions: RHR has emerged as an unequivocally powerful technique for the management of GHs. OHR remains the technique of choice for local/regional anesthesia, posterior recurrences, and in centers that lack other platforms. In low- and middle-income countries, OHR is the most utilized technique. Centers of excellence should offer all techniques of repair including WW.

Missed Diagnosis: Case of Strangulated Femoral Richter’s Hernia in an Elderly Woman

Abstract Femoral hernias are rare but can occur and sometimes present with strangulation because of the narrow opening in the femoral canal. They are commoner in elderly women, and sometimes the diagnosis could be missed. We managed the case of a 77-year-old woman who was said to have undergone a “repair of an inguinal hernia” at a private hospital where she presented with a strangulated groin swelling. However, symptoms of bowel obstruction persisted post-operatively, necessitating the referral to our facility. On presentation, she was resuscitated, and intra-operative findings revealed a strangulated Richter’s femoral hernia. A wedge resection and anastomosis was done and the hernia defect repaired. She improved well and was subsequently discharged. Thus, the finding of complicated groin swelling should heighten the suspicion of the attending surgeon for a femoral hernia and provoke a detailed clinical examination so as to prevent delay in diagnosis, provide prompt intervention, and improve clinical outcomes. This is important particularly in our setting where hernia repairs are the most common surgeries done, yet advanced imaging modalities are not always accessible for accurate pre-operative diagnosis.

Acceptance of Open Preperitoneal Repair in Inguinal Hernia Surgery Delphi-Consensus After an Anonymous International Survey Among European Hernia Society Members

IntroductionFor years, the Lichtenstein technique was the gold standard for open repair, but several open pre-peritoneal techniques have developed since the fifties of the 20th century that offer some benefits over the Lichtenstein technique in terms of post-surgical incidence of pain. Since the 2023 update of the International HerniaSurge Guidelines, open preperitoneal mesh techniques have been an acceptable alternative, providing available expertise and competence with at least equal results as Lichtenstein repair.AimThe aim of this project is to understand the views of surgeons regarding the approach to inguinal hernia repair and determine best practice principles for optimal surgical outcomes.MethodsUsing a modified Delphi method, a panel of experts developed 43 Likert scale statements across six key domains. These statements were used to develop an online survey distributed to surgeons in Europe involved in inguinal hernia repair. The threshold for consensus was set a priori at 75%.ResultsA total of 202 responses were received from surgeons involved in inguinal hernia repair over three rounds of survey. After the initial survey round, seven statements were revised and reissued for a further round. At the conclusion of the survey phase, 31 of the 38 remaining statements achieved consensus (of which 13 achieved ≥90% agreement). From these results, the panellists developed a set of 3 recommendations to help define principles for optimal approach to inguinal hernia repair. Accordingly Open preperitoneal techniques seems to be an alternative to Lichtenstein technique if expertise is available and should be included in a tailored concept. Knowledge of anatomy, Education and Training in open preperitoneal techniques is crucial for the acceptance of these techniques.ConclusionThe proposed set of recommendations provides some principles for surgeons to consider when selecting an approach to inguinal hernia repair, ensuring good patient outcomes in a practical and cost-effective manner.

A retrospective cohort study of laparoscopic enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) repair of incisional ventral hernias in patients with morbid obesity

Abstract Background Incisional hernia (IH) repair in morbidly obese (MO) patients poses significant challenges due to higher risks of complications and recurrence. Traditional open repairs are linked to increased morbidity, driving interest in minimally invasive techniques. The enhanced view totally extra-peritoneal Rives-Stoppa (eTEP-RS) technique shows promise as a laparoscopic method for IH repair, but data on its efficacy and safety in MO patients are limited. This study aims to evaluate the efficacy, safety, and feasibility of the eTEP-RS approach specifically for IH repair in this high-risk population. Methods Analysis of a retrospective cohort of consecutive patients undergoing laparoscopic eTEP-RS for IH repair between 2017 and 2022 which included 135 patients, categorized into two groups based on body mass index (BMI): the MO group (BMI > 35 kg/m2) and the control group (BMI ≤ 35 kg/m2). We compared demographics, comorbidities, hernia characteristics, intra-operative data, post-operative outcomes, and hernia recurrence rates. Results Patients in the MO group had significantly more type 2 diabetes mellitus (n = 18, 51% vs n = 25, 25%; p = 0.004), hypertension (n = 35, 73% vs n = 75, 53%; p = 0.017), dyslipidemia (n = 29, 60% vs n = 58, 41%; p = 0.021), ASA score 3 (n = 18, 52% vs n = 23, 23%; p = 0.004), a history of previous umbilical hernia repair (n = 13, 27% vs n = 13, 9.2%; p = 0.002), and bariatric surgery (n = 10, 29% vs n = 13, 13%; p = 0.035). There were no differences in intra-operative characteristics, operative times, or intra-operative complications between groups. During a median follow-up period of 1 year (IQR 40–680 days), there were no differences in hernia recurrence (n = 2, 5.7% vs n = 9, 9%; p = 0.07), time to recurrence, or chronic analgesia usage between groups. Conclusion The laparoscopic eTEP-RS approach was safe and effective for IH repair in patients with MO, demonstrating comparable post-operative outcomes and recurrence rates to those with a lower BMI in a selected cohort of patients.

Gastric cancer metastasizing to the male reproductive system.

A 71-year-old male patient underwent a radical gastrectomy for gastric cancer two years prior and subsequently received regular postoperative chemotherapy with capecitabine and oxaliplatin. Six months before admission, he experienced the onset of swelling in the right inguinal region, accompanied by pain in the right lower abdomen during ambulation. He was admitted to the hospital due to the progressive enlargement of the swelling and the onset of severe abdominal pain. Physical examination revealed a protruding mass in the right groin, which was apparent upon standing and did not recede upon compression of the internal ring orifice. During the unilateral inguinal hernia repair procedure, multiple nodular masses were identified at the internal ring's opening, with the largest measuring approximately 2 cm in diameter and exhibiting a hard texture. Subsequent tissue excision for pathological analysis revealed heterogeneous cellular structures and swelling that extended along the spermatic cord, reaching the vas deferens and spermatic vessels, and invading the peritoneum. The hernial sac was smooth and devoid of hernial contents, leading to the resection of the affected peritoneum. During the surgical procedure, the spermatic cord was transected and ligated proximal to the testis, followed by its removal. Subsequently, the posterior wall of the inguinal canal was reinforced with sutures, the surgical field was irrigated with no evidence of active bleeding, and the incision was closed. Histopathological analysis revealed metastatic involvement of the spermatic cord and testis by gastric cancer, thereby confirming ectopic metastasis of the malignancy.

Comparing Open and Robotic Unilateral Transversus Abdominis Release in Incisional Hernias With a Lateral Component: A Single Center Retrospective Study

IntroductionLateral hernias are often more challenging to correct when compared to midline defects, due to the anatomic boundaries of the bony pelvis, retroperitoneum, and costal margin. With the insurgence of robot assisted abdominal wall surgery, these defects have been found more manageable through a minimal invasive repair. In this study, we aim to present our short-term results of incisional hernia repair with a lateral component requiring a unilateral transversus abdominis release, through open surgery versus robot assisted.MethodsA retrospective analysis was performed of our robotic and open abdominal wall repairs of lateral hernias, where a unilateral transversus abdominis release was performed, between January 2017 and December 2023. Patient, hernia and perioperative details are reported.Results54 patients in the open group versus 10 patients in the robotic group were included. Hernia width and hernia surface area were higher in the open group, but not significant. Operation time was similar between open and robotic procedures. In-hospital complications, surgical site infection and clinical seroma rate during the first 30 postoperative days were similar in both groups. There was a clear difference in length of stay, in favor of the robotic group.DiscussionIn our limited series, a robotic approach seems safe and feasible when faced with large lateral hernias. Short-term results show a shorter length of stay using the robotic approach, with no significant difference in short term complications, specifically SSI-rate. However, conclusions are limited due to the low number of patients and additional studies should be performed to account for long term recurrence and increase included patient number.

Laparoscopic hiatal hernia augmentation following sleeve gastrectomy using a “mesh sling” tethered to ligamentum teres – Case report of a novel technique

Symptomatic hiatal hernia following sleeve gastrectomy is a well known and documented complication. The gold standard for its treatment is to perform a hiatal hernia repair combined with conversion of the sleeve to a gastric bypass. However, in some patients a gastric bypass may not be indicated or the patient may be unwilling for the conversion. In these situations, the ligamentum teres augmentation combined with hiatal hernia crural repair seems to be the most effective and popular, according to a literature survey. To avoid damaging the sleeve, the use of prosthetic materials to augment the hiatal repair is generally not recommended. In this case report, for a patient who presented with a hiatal hernia with severe reflux following a sleeve gastrectomy, we describe a novel technique where a sling composed of a strip of composite mesh was loosely placed around the gastroesophageal junction and tethered to a shortened ligamentum teres.

The Lichtenstein Technique In Inguinal Hernioplasty: Quantitative Analysis Of Outcomes In Surgical Emergencies

Objective: This study aims to systematically and quantitatively analyze the outcomes of the Lichtenstein technique in inguinal hernioplasty performed in emergency settings, focusing on its effectiveness, safety, and impact on postoperative recovery. Theoretical Framework: Inguinal hernias are among the most common surgical conditions worldwide, with the Lichtenstein technique established as the gold standard for repair due to its simplicity, low recurrence rates, and effectiveness. However, its application in emergency scenarios presents unique challenges, including higher risks of complications and longer recovery times. Studies have compared the Lichtenstein technique to other approaches, such as laparoscopic and Desarda methods, to assess its suitability for urgent surgical interventions. Method: A systematic review was conducted using PubMed, Scopus, and Web of Science databases to identify relevant studies published between 2014 and 2024. The inclusion criteria focused on studies analyzing postoperative outcomes, recurrence rates, and complications in emergency inguinal hernia repairs using the Lichtenstein technique. Exclusion criteria eliminated studies without an emergency context, insufficient outcome data, and non-English publications. Results and Discussion: The review findings indicate that the Lichtenstein technique offers favorable outcomes in emergency settings, with low recurrence rates and reduced operative time compared to other techniques. However, concerns about mesh-related complications, infection risks, and postoperative pain necessitate careful patient selection and adherence to surgical best practices. Studies comparing the technique to laparoscopic and non-mesh approaches suggest that while Lichtenstein remains a reliable choice, alternative methods may offer benefits in specific clinical scenarios. Research Implications: This study highlights the need for further large-scale, multicenter research to establish standardized protocols and optimize surgical strategies for emergency inguinal hernia repair. Future studies should focus on long-term outcomes, cost-effectiveness, and patient-centered factors such as pain management and quality of life. Originality/Value: This systematic review provides valuable insights into the efficacy and safety of the Lichtenstein technique in emergency hernioplasty, offering evidence to support clinical decision-making and improve surgical outcomes in high-risk patients.

Intentional weight reduction before surgery - A systematic review.

Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200kcal/day) or very low energy diet (VLED, ≤800kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine. The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses. A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95% CI 0.14-0.59, p=0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51-0.79, p<0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes. The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures. The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.

Wearable, noninvasive, pulsed shortwave (radiofrequency) therapy for postoperative analgesia: A randomized, double-masked, sham-controlled pilot study.

Nonthermal, pulsed shortwave (radiofrequency) therapy (PSWT) is a nonpharmacologic, noninvasive modality that limited evidence suggests provides analgesia. Its potential favorable risk-benefit ratio stems from its lack of side effects and significant medical risks, applicability to any anatomic location, long treatment duration, and ease of application by simply affixing it with tape. Even with a relatively small treatment effect, PSWT might contribute to a multimodal analgesic regimen, similar to acetaminophen. However, widespread clinical use is hindered by a lack of systematic evidence. The current randomized, controlled pilot study was undertaken to determine the feasibility and optimize the protocol for a subsequent definitive investigation and estimate the treatment effect of PSWT on postoperative pain and opioid consumption. Within the recovery room following primary knee and hip arthroplasty, cholecystectomy, hernia repair, and non-mastectomy breast surgery, we applied 1-3 PSWT devices (Model 088, BioElectronics Corporation, Frederick, Maryland) over the surgical bandages. Participants were randomized to 28 days of either active or sham treatment in a double-masked fashion. The outcomes of primary interest were the cumulative opioid consumption and the mean of the "average" and "worst" daily pain measured with the Numeric Rating Scale over the first 7 postoperative days. During the first 7 postoperative days, oxycodone consumption in participants given active treatment (n = 55) was a mean (SD) of 21 mg (24) versus 17 mg (26) in patients given sham (n = 57): difference 4 (95% CI, -5 to 13), p = 0.376. During this same period, the "average" daily pain intensity in patients given active treatment was 2.4 (1.6) versus 2.6 (1.7) in sham: difference -0.2 (95% CI -0.8 to 0.5), p = 0.597. Concurrently, the worst/maximum pain for the active group was 4.6 (2.0) versus 4.7 (2.1) in sham: difference -0.1 (95% CI -0.8 to 0.7), p = 0.888. No device-related systemic side effects or serious adverse events were identified. Pulsed shortwave (radiofrequency) therapy did not reduce pain scores and opioid requirements to a statistically significant or clinically relevant degree during the initial postoperative week in this pilot study. These results must be replicated with a subsequent study before being considered definitive. Data from this preliminary study may be used to help plan future trials.

RETRACTION: Wound Cosmesis Problems and Other Postoperative Problems of Laparoscopic Compared to Open Paediatric Inguinal Hernia Repair: A Meta-Analysis.

Q. Li, S. Liu, X. Ma, and J. Yu, "Wound Cosmesis Problems and Other Postoperative Problems of Laparoscopic Compared to Open Paediatric Inguinal Hernia Repair: A Meta-Analysis," International Wound Journal 20, no. 9 (2023): 3665-3672, https://doi.org/10.1111/iwj.14257. The above article, published online on 11 June 2023, in Wiley Online Library (http://onlinelibrary.wiley.com/), has been retracted by agreement between the journal Editor in Chief, Professor Keith Harding; and John Wiley & Sons Ltd. Following an investigation by the publisher, all parties have concluded that this article was accepted solely on the basis of a compromised peer review process. The editors have therefore decided to retract the article. The authors did not respond to our notice regarding the retraction.

Laparoscopic Inguinal Hernia Repair: Risk Factors and the Clinical Effect of Seroma Formation.

Laparoscopic Inguinal Hernia Repair: Risk Factors and the Clinical Effect of Seroma Formation.

The fat of the matter: an unexpected case of fat embolism syndrome after elective hernia repair

The fat of the matter: an unexpected case of fat embolism syndrome after elective hernia repair

A retrospective nationwide comparison of laparoscopic vs open inguinal hernia repair in children

BackgroundUtilization of the laparoscopic approach for inguinal hernia repair has increased significantly over the past decade. The purpose of this study is to compare rates of second hernia operation and same side recurrence following open and laparoscopic inguinal hernia repair in a large national cohort. MethodsThis retrospective analysis utilized the Pediatric Health Information System database to identify children <18 years-old who underwent laparoscopic or open primary inguinal hernia repair from 2017-2021. Data were collected through 2022 to allow minimum one year follow-up. Second hernia operation rates, inclusive of same side recurrence and metachronous contralateral hernia, and same side recurrence rates were compared by multivariable mixed effects model controlling for confounders and institutional clustering. Misclassification rates were determined through data validation at four constituent institutions. Sensitivity analyses determined true outcome rates. ResultsWe identified 53,287 operations (15.6% laparoscopic). Rate of second hernia operation was greater following laparoscopic repair (2.9% vs 2.6%, p=0.04) with no difference on multivariable analysis (OR 1.14, 95% CI 0.98-1.32). Same side recurrence rate was greater following laparoscopic repair (1.5% vs 0.4%, p<0.001) which persisted on multivariable analysis (OR 3.72, 95% CI 2.90-4.78). Sensitivity analysis demonstrated true laparoscopic and open repair rates of 14.2% and 85.8%, respectively. True rates of second hernia operation and same side recurrence were identical to those determined by PHIS. ConclusionLaparoscopic inguinal hernia repair in children has more than three times the odds of same side hernia recurrence than open repair which is balanced by a reduced rate of second operation for metachronous hernia. Level of EvidenceTreatment Study – Level III

Percutaneous inguinal canal semi-closure during laparoscopic repair for large indirect inguinal hernia.

Factors such as a large lateral hernia and insufficient prosthetic overlap have been associated with hernia recurrence after laparoscopic transabdominal preperitoneal (TAPP) repair. The effectiveness of defect closure in reducing recurrence during laparoscopic hernia repair has been previously reported. We developed a novel technique called percutaneous inguinal canal semi-closure (PICS) to reinforce laparoscopic mesh repair. To assess whether this technique is both safe and practical in a clinical setting, focusing on postoperative factors such as recurrence, complications, and postoperative pain. A retrospective analysis of consecutive patients undergoing TAPP for L3 hernia repair. In total, 58 patients who underwent TAPP for L3 inguinal hernias were included, 27 of whom (46.6%) underwent TAPP with PICS, while 31 (53.4%) underwent standard TAPP without PICS. No recurrences were observed in the PICS group, compared to two recurrences in the control group, although this difference did not reach statistical significance. The incidence of postoperative complications was comparable between groups (48.1% vs. 45.2%, respectively). The median procedure time of PICS was 7.3min. Patients in the PICS group reported higher pain scores than the control group for up to 21days postoperatively, but no chronic pain was observed in either group. The modified laparoscopic technique involving PICS for large indirect inguinal hernias appears safe and feasible.

POST-CAUDAL BLOCK PRIAPISMIN CHILDREN: ARARE COMPLICATION NOT TO BEUNDERESTIMATED

Caudal anesthesia, commonly used in pediatric sub-umbilical surgeries, is well-regarded for its safety and simplicity. However, rare complications such as priapism may occur. We report the case of a 4-year-old child undergoing inguinal hernia repair who developed pulsatile priapism following a caudal block with bupivacaine. The complication was managed through deepening of anesthesia and symptomatic measures, with spontaneous resolution after 5 hours and no long-term sequelae. This case highlights a potential reflexogenic mechanism involving parasympathetic hyperactivity due to sympathetic fiber blockade. Although rare, post-caudal block priapism requires heightened vigilance and prompt management to prevent serious complications.

Open Versus Minimally Invasive Morgagni Hernia Repair in Pediatric Surgery: A Review.

Background: Morgagni hernia (MH), a rare type of congenital diaphragmatic hernia, does not have an established protocol for surgical repair. Materials and Methods: A MEDLINE search with terms related to various surgical approaches to repair MH in children was conducted. Articles comprising robotic-assisted surgery, laparoscopy, laparotomy, thoracoscopy, and thoracotomy over the last 20 years were assessed. Results: This narrative review provides an overview of MH in the pediatric population, covering the epidemiology, diagnosis, and management of this rare diaphragmatic hernia. We discuss various surgical techniques, including open and minimally invasive approaches, and compare their advantages and limitations in childhood MH repair. In addition, we address arguments for and against controversial topics such as hernia sac excision and patch reinforcement. Conclusions: Regarding MH in children, transabdominal repair is superior to transthoracic due to improved visualization of bilateral defects and easier reduction of the hernia contents. Laparoscopy has been reported as a popular approach. Single-site laparoscopy has gained attention due to better outcomes than standard three-port laparoscopy. Considering a limited number of children in the literature who underwent robotic MH repair, perioperative complications were reported to be minor.

Is Minimally Invasive Surgery the Standard of Care for Ventral Hernia Repair?

Is Minimally Invasive Surgery the Standard of Care for Ventral Hernia Repair?

Retrospective comparative cohort analysis of Darn and Lichtenstein repair methods for bilateral inguinal hernias in adult males in a low-resource setting: a single-centre study in Sudan

Background: Inguinal hernias are a common surgical condition that, if untreated, can lead to severe complications. Bilateral inguinal hernias add challenges due to increased recurrence and postoperative risks. Although Lichtenstein repair, a mesh-based approach, is the gold standard for its low recurrence, Darn repair – a mesh-free technique – offers a cost-effective alternative in low-resource settings. This study assesses the applicability and effectiveness of both techniques for bilateral inguinal hernias in a resource-limited environment. Materials and methods: With Institutional Review Board (IRB) approval from Al-Waleedeen Specialized Hospital (IRB number WAD.12.01.2021), a retrospective cohort analysis was conducted on 75 adult males who underwent bilateral inguinal hernia repair from January 2021 to October 2023 in Sudan. Patients were divided into Group A (Lichtenstein, n = 30) and Group B (Darn, n = 45). Data on operative time, complications, hospital stay, return to normal activities, patient satisfaction, and economic impact were collected, with a three-month follow-up. Results: Darn repair showed fewer postoperative complications, particularly lower surgical site infections (SSI) (8% vs. 20%, P = 0.014). It also had shorter operative times (mean 30 minutes less), reduced hospital stays (1.5 vs. 2.8 days, P &lt; 0.0001), and lower costs. Recurrence rates were comparable across both groups. Conclusion: While both methods yielded similar recurrence rates, Darn repair showed advantages in resource-limited settings, with fewer complications, shorter hospital stays, and lower costs, making it a practical option when mesh is not readily available. Limitations include retrospective design, convenience sampling, and possible recall bias from phone follow-ups. The three-month follow-up may not capture long-term outcomes like chronic pain or late recurrences. Future studies should extend follow-ups and conduct prospective trials to optimize Darn repair across diverse settings