Single-side open groin hernia repair with mesh or without mesh: Which is the best?

Background: Groin hernia repair, which is a common operation performed by general surgeons, is still a controversial issue. Although some surgeons recommend mesh repair as the gold standard, the mesh also has its complications. In this study, it was aimed to investigate whether there is an advantage of using mesh in unilateral groin hernia operations. Methods: Patients who were operated on for groin hernia with open surgery at Erzurum Regional Education and Research Hospital, Erzurum, Turkey between 2019 and 2021 were selected for the study retrospectively. After collecting data of the patients, patients were divided into two groups according to mesh usage. Differences between the group in which mesh was used and the group without mesh were evaluated. Results: 173 patients were operated on with open surgery due to groin hernia, and 163 (94.2%) were men. The mean age of all patients was 51.29±18.24 (range from 19 to 91). 84 (48.6%) patients were operated on with mesh, while 89 (51.4%) patients were operated on without mesh. The use of mesh was more common in the elderly (p<0.001). Comorbidity (p=0.042) and the need for a drainage catheter (p<0.001) were higher in the mesh group. Concomitant spermatic cord lipoma (p<0.001), length of hospital stay was longer (p=0.002) and mean rank of leucocyte count was higher (p=0.023) in the non-mesh group. In addition, the use of mesh decreased testicular complications (p=0.029). Conclusions: The use of mesh in groin hernia surgery is more preferred in elderly patients and patients with the comorbid disease, while the leukocyte count is higher and the need for additional imaging is higher in repairs performed without the use of mesh. The presence of cord lipoma during surgery was higher in surgeries without mesh, and the need for a drainage catheter was higher in the mesh group. The hospital stay was longer in cases without mesh with longer postoperative follow-up. Also, the use of mesh in cases does not affect the overall morbidity and recurrence. We emphasize that groin hernia surgeries without mesh can be performed safely like repair with mesh.