Inguinal hernia repair is among the most commonly performed surgical procedures globally, accounting for millions of operations annually¹. The lifetime risk of developing an inguinal hernia is approximately 27% in men and 3% in women². Surgical repair remains the definitive treatment, aiming to relieve symptoms, prevent complications such as incarceration or strangulation, and minimize recurrence³.

Historically, tissue-based repairs such as the Bassini and Shouldice techniques were widely practiced⁴. These methods involve suturing adjacent tissues under tension to close the defect, often leading to postoperative discomfort and higher recurrence rates⁵. Recurrence rates for traditional repairs have been reported between 5–15% depending on surgeon expertise and patient factors⁶.

The introduction of prosthetic mesh in the late 20th century revolutionized inguinal hernia surgery⁷. The Lichtenstein tension-free mesh repair became the gold standard due to its simplicity and reduced recurrence rates, often below 2%⁸. Mesh repair works by reinforcing the posterior wall of the inguinal canal without tension, promoting fibrous ingrowth and durable repair⁹.

Despite its advantages, mesh implantation is associated with specific complications including foreign body reaction, chronic groin pain, mesh infection, and rarely mesh migration¹⁰. Chronic postoperative inguinal pain (CPIP) remains a significant concern, affecting up to 10–15% of patients¹¹. Neuropathic injury to ilioinguinal or genitofemoral nerves may contribute to persistent pain¹².

Non-mesh repairs, while less commonly performed today, may be preferred in contaminated fields, young patients, or where mesh availability is limited¹³. They avoid foreign material implantation and may reduce mesh-related complications¹⁴. However, they are associated with higher tension and increased recurrence risk¹⁵.

Several randomized trials and meta-analyses have compared mesh and non-mesh repairs¹⁶⁻¹⁸. While mesh repair consistently demonstrates lower recurrence, results regarding chronic pain and wound complications remain mixed¹⁹. Therefore, continued evaluation of postoperative outcomes is essential to guide surgical decision-making.

This study aims to compare postoperative complications, including early morbidity and late outcomes, between mesh and non-mesh inguinal hernia repair.

MATERIALS AND METHODS

This prospective comparative study was conducted in the Department of General Surgery at a tertiary care hospital over 18 months.

Study Population

A total of 120 patients diagnosed with primary unilateral inguinal hernia and scheduled for elective surgery were included.

Inclusion Criteria

• Age 18–75 years
• Primary unilateral reducible inguinal hernia
• ASA grade I–III
• Willing to provide informed consent

Exclusion Criteria

• Recurrent hernia
• Bilateral hernia
• Complicated hernia (obstructed/strangulated)
• Previous lower abdominal surgery
• Immunocompromised patients
• Patients with coagulopathy

Study Groups

Patients were randomized into:

• Group A (n=60): Mesh repair (Lichtenstein technique)
• Group B (n=60): Non-mesh repair (Shouldice/Bassini)

Surgical Procedure

All surgeries were performed under spinal anesthesia. Standard open inguinal approach was used. In Group A, polypropylene mesh was placed over the posterior wall. In Group B, posterior wall reinforcement was performed using sutured tissue approximation.

Postoperative Assessment

Patients were monitored for:

• Operative time
• Pain score (VAS at 24h and 72h)
• Wound infection
• Seroma
• Hematoma
• Hospital stay
• Chronic groin pain (after 3 months)
• Recurrence (6 months follow-up)

Statistical Analysis

Data were analyzed using SPSS version 25. Continuous variables were expressed as mean ± SD. Categorical variables were compared using Chi-square test. p<0.05 was considered statistically significant.

RESULTS

Table 1: Demographic Characteristics

Both groups were comparable demographically.

Table 2: Operative Time

Non-mesh repair required significantly longer operative time.

Table 3: Early Postoperative Complications

No statistically significant difference in early complications.

Table 4: Postoperative Pain (VAS)

Pain scores were comparable.

Table 5: Chronic Groin Pain (3 months)

Slightly higher in mesh group but not significant.

Table 6: Recurrence (6 months)

Recurrence significantly higher in non-mesh group.

DISCUSSION

The present study demonstrates that mesh repair significantly reduces recurrence compared to non-mesh repair, consistent with contemporary literature¹⁶⁻¹⁸. Tension-free repair minimizes tissue strain, explaining the lower recurrence rates. Similar findings were reported in Cochrane analyses, which identified mesh repair as superior in preventing recurrence²⁰.

Operative time was significantly shorter in mesh repair, aligning with studies showing technical simplicity of Lichtenstein repair²¹. Although seroma formation was slightly higher in mesh repair, the difference was not statistically significant. This may be attributed to foreign body reaction and dead space formation²².

Chronic groin pain remains controversial. While some studies suggest increased neuropathic pain with mesh²³, others report comparable rates between techniques²⁴. In our study, chronic pain was marginally higher in mesh repair but not statistically significant.

Infection rates were similar in both groups, consistent with modern sterile techniques and prophylactic antibiotics²⁵. Importantly, recurrence was significantly higher in non-mesh repair, supporting the continued preference for mesh-based techniques in elective cases.

Overall, findings support mesh repair as the standard of care in adult inguinal hernia surgery.

CONCLUSION

Mesh (Lichtenstein) repair provides significantly lower recurrence rates compared to non-mesh repair, with comparable early postoperative complications. Although chronic pain and seroma may be slightly higher in mesh repair, benefits outweigh risks. Mesh repair remains the preferred technique for primary inguinal hernia.

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