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Comparing Lichtenstein with darning for inguinal hernia repair in an African population



Being a relatively new entrant into our practice, mesh repair has not been compared with previously existing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications, recovery and cost.


Patients with uncomplicated, primary inguinal hernia were randomized to have their hernias repaired either by the Lichtenstein or darning technique. Details of their socio-demographic, hernia characteristics and intra-operative findings were recorded. Postoperatively patients were assessed for pain, wound site complications and recurrence. Both direct and indirect costs were calculated. Mean duration of follow-up was 7.5 months.


Sixty-seven patients were studied. Thirty-three had Lichtenstein repair while 34 had darning repair. Lichtenstein repair was associated with less post-operative pain, less analgesic requirement, and shorter time of return to work activities, these were all statistically significant (p < 0.05). Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest. There was no recurrence in any of the groups. Total cost was comparable between the two groups.


Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are comparable in terms of frequency of early post-operative complications and total cost.

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  1. Bekker J, Keeman JN, Simons MP, Aufenacker TJ (2007) A brief history of the inguinal hernia operation in adults. Ned Tijdschr Geneeskd 151(16):924–931

    CAS  PubMed  Google Scholar 

  2. Zsolt B, Csiky M (2001) Recurrence rate in Bassini operation after five years. Magy Seb 54(5):307–308

    CAS  PubMed  Google Scholar 

  3. Shouldice EB (2003) The Shouldice repair for groin hernias. Surg Clin N Am 83(5):1163–1187

    Article  PubMed  Google Scholar 

  4. Kingsnorth AN, Gray MR, Nott DM (1992) Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia. Br J Surg 79(10):1068–1070

    CAS  Article  PubMed  Google Scholar 

  5. Panos RG, Beck DE, Maresh JE, Harford FJ (1992) Preliminary results of a prospective randomized study of Cooper’s ligament versus Shouldice herniorrhaphy technique. Surg Gynecol Obstet 175(4):315–319

    CAS  PubMed  Google Scholar 

  6. Moloney GE, Gill WG, Barclay RC (1948) Operations for hernia; technique of nylon darn. Lancet 2(6515):45–48

    CAS  Article  PubMed  Google Scholar 

  7. Hernias AJ, Zinner MJ (eds) (1997) Maingot’s abdominal operations, 10th edn. Appleton and Lange, Conneticut, pp 479–580

    Google Scholar 

  8. Moloney GE (1972) Darning inguinal hernias. Arch Surg 104(2):129–130

    CAS  Article  PubMed  Google Scholar 

  9. Farooq O, Batool Z, Bashir R (2005) Prolene Darn: safe and effective method for primary inguinal hernia repair. J Coll Phys Surg Pak 15(6):358–361

    Google Scholar 

  10. Olasehinde O, Adisa AO, Agbakwuru EA, Etonyeaku AC, Kolawole AO, Mosanya AO (2015) A five year review of darning technique of inguinal hernia repair. Niger J Surg 21(1):52–55

    Article  PubMed  PubMed Central  Google Scholar 

  11. EU Hernia Trialist Collaboration (2002) Repair of groin hernia with synthetic mesh: meta-analysis of randomized controlled trials. Ann Surg 235(3):322–332

    Article  Google Scholar 

  12. Arowolo OA, Agbakwuru EA, Adisa AO, Lawal OO, Ibrahim MH, Afolabi AI (2011) Evaluation of tension-free mesh inguinal hernia repair in Nigeria: a preliminary report. West Afr J Med 30(2):110–113

    CAS  PubMed  Google Scholar 

  13. Usoro NI, Agbor C, Emelike K, Bamidele A (2008) Early outcome of inguinal hernia repair using ultrapro mesh in University of Calabar Teaching Hospital Nigeria. Internet J Third World Med 6(2):2

    Google Scholar 

  14. Breivik H, Boorchgrevink PC, Allen SM, Rosseland SA, Romundstad L, Hals EK et al (2008) Assessment of pain. Br J Anaesth 101(1):17–24

    CAS  Article  PubMed  Google Scholar 

  15. Bailey IS, Karran SE, Toyn K, Brough P, Ranaboldo C, Karran SJ (1992) Community surveillance for complications after hernia surgery. Br Med J 304:469–471

    CAS  Article  Google Scholar 

  16. The World Bank development report, 2012

  17. Carbonell JF, Sanchez JL, Peris RT et al (1993) Risk factors associated with inguinal hernias: a case control study. Eur J Surg 159:481

    CAS  PubMed  Google Scholar 

  18. Flich J, Alfonso JL, Delgado F et al (1992) Inguinal hernia and certain risk factors. Eur J Epidemiol 8:277 PMID: 1644149

    CAS  Article  PubMed  Google Scholar 

  19. Hair A, Paterson C, Wright D, Baxter JN, Dwyer PO (2001) What effect does the duration of an inguinal hernia have on patient symptoms. J Am Coll Surg 192(2):12–19

    Google Scholar 

  20. Imamuddin B, Sher MS, Iasmeen I, Ghulam S, Rajib AD (2010) Moloney darn repair: versus Lichenstien mesh repair comparison of Cost effectiveness and complications. Med Channel 16(1):81–84

    Google Scholar 

  21. Hussain A, Aamer N, Asad MM (2007) Pakistan armed forces medical journal 57(1):23–27

  22. Chakraborty S, Mukherjee A, Bhattacharya M (2007) Tension-free inguinal hernia repair comparing’darn’with’mesh’: a prospective randomized controlled clinical trial. Indian J Surg 69(2):52–56

    Google Scholar 

  23. Kaynak B, Celik F, Guner A, Guler K, Kaya MA, Celik M (2007) Moloney darn repair versus lichtenstein mesh hernioplasty for open inguinal hernia repair. Surg Today 37(11):958–960

    Article  PubMed  Google Scholar 

  24. Farah S, Brygel M (2012) Short term pain and return to activities following Lichtenstein inguinal hernia repair. Internet J Surg 28(2):140053

    Google Scholar 

  25. Zedan AM (2009) Inguinal hernioplasty by darning versus prosthetic mesh. Tikrit Med J 15(1):158–162

    Google Scholar 

  26. Koukourou A, Lyon W, Rice J, Wattchow DA (2001) Prospective randomized trial of polypropylene mesh compared with nylon darn in inguinal hernia repair. Br J Surg 88(7):931–934

    CAS  Article  PubMed  Google Scholar 

  27. Sanchez-Manuel FJ, Lozano-Garcia J, Seco-Gil JL (2012) Antibiotic prophylaxis for hernia repair. Cochrane Database Syst Rev 2007(3):CD003769

    Google Scholar 

  28. Farah S, Brygel M (2012) Short term pain and return to activities following Lichtenstein inguinal hernia repair. Internet J Surg 28(2):14005

    Google Scholar 

  29. O’Dwyer PJ, Alani A, McConnachie A (2005) Groin hernia repair: postherniorrhaphy pain. World J Surg 29(8):1062–1065

    Article  PubMed  Google Scholar 

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Correspondence to O. Olasehinde.

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Olasehinde O, Lawal O.O, Agbakwuru E.A, Adisa A.O, Alatise O.I, Arowolo A.A, Adesunkanmi A.R.K, Etonyeaku A.C declare no conflict of interest.

Statement of human and animal rights

Ethical approval was obtained from the Ethics and Research committee of the Obafemi Awolowo University Teaching Hospitals Complex, Ile‐Ife. This study was conducted in accordance with the ethical standards of the ethical committee of the Obafemi Awolowo University Teaching Hospitals Complex Ile‐Ife, Nigeria.

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Informed consent was obtained from all the patients in this study.

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Olasehinde, O., Lawal, O.O., Agbakwuru, E.A. et al. Comparing Lichtenstein with darning for inguinal hernia repair in an African population. Hernia 20, 667–674 (2016).

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  • Inguinal
  • Hernia
  • Mesh
  • Darning
  • Lichtenstein