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.

Abstract

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 < 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.