Tension-free inguinal hernia repair comparing 'darn' with 'mesh': a prospective randomized controlled clinical trial.

Background: Tension-free inguinal hernioplasty is sine-qua-non for a good hernia repair and is aptly fulfilled by both Lichtenstein’s mesh and a correctly done Abrahamson’s darn. Aims: This study compares the increasingly popular, yet costly, Lichtenstein’s mesh repair with the classical Abrahamson’s darn repair for inguinal hernia. Materials and Methods: A randomized, bias-free study was conducted on 240 patients with blinding adopted during the computation of results. All 240 patients, underwent 240 repairs after being randomized into 2 groups. 120 repairs were done with prolene mesh secured with 2-0 prolene sutures, while the other 120 patients underwent a 3-layered darn repair using 1-0 prolene sutures over a 2-0 prolene posterior bed. Duration of surgery and ergonomics were noted for each case. Results: The operative time was comparable (mean of 38 min for the darn group and 36 min for the mesh group), (P> 0.5; insignificant), using Fisher’s exact ‘t’ test being > 0.5 and hence insignificant. Postoperative complications were minimal in both series. Both groups recorded no recurrences till date. However, darning scored better than mesh when cost of the mesh and darn sutures were compared, other factors being similar. Conclusion: Mesh repair is definitely the more popular version of the two but in countries where cost factors still play a part and prevent many from seeking early treatment, a well constructed darn is an equally effective and less costly treatment option for inguinal hernias.