Comparison of Modified Darn Repair and
Mesh Repair for Inguinal Hernia:
Randomized Control Trial
Original Article
06
Keywords: Hernia surgery, Mesh repair, Modified darn repair, Postoperative complications, Recurrence rate
MS NO.: PJMDS/OA/036/2024
Pak J Med Dent Sci. 2025;2(1):06-12
Inguinal hernia is one of the most common types of surgical
pathological entity, reaching a lifetime prevalence of 25% in
1
men and 2% in women . The elderly are particularly affected by
this condition, and one study reported that nearly half of all
1
hernias in males are diagnosed in the aged . Inguinal hernia
repair is one of the most frequently performed general surgical
procedures worldwide owing to its high prevalence.
Approximately 1 million abdominal wall hernia repairs are
performed per year in the United States, 770,000 of which are
2
for inguinal hernias . Although surgical techniques
have undergone an evolutionary process, they represent a
historical continuum and the myriad makeups of effectiveness,
safety and recovery are still debated amongst surgeons.
INTRODUCTION
For decades, the Lichtenstein tension-free mesh repair (LMR)
has remained the most viable surgical approach due to its
3
low recurrence rates and long-term safety profile . However,
the increasing concerns about chronic postoperative pain,
foreign body reactions, and mesh-related complications have
encouraged scientists and surgeons to search for
4–6
different treatment methods . One such solution to these
issues might be the Modified Darn Repair (MDR),
which appears to supplement the weakened abdominal wall
with reinforcement without the use of a permanent mesh. At the
same time, MDR has been reported to offer similar or even
better postoperative recovery, pain, and recurrence
7,8
outcomes than the most common surgical approaches .
The darning repair technique offers an economical alternative
to mesh-based approaches, particularly in settings where
access to synthetic mesh is constrained due to financial or
logistical limitations. This technique utilizes commonly
available suturing materials, making it more feasible in
resource-limited environments. In contrast, mesh-based
techniques such as the Lichtenstein procedure often require
specialized materials and training⁹.
Several studies have evaluated differences between the
MDR and the Lichtenstein technique in terms of mean
operative time, post-operative pain and recurrence rates.
Recent comparative studies evaluating the modified darn
repair (MDR) versus mesh-based techniques have revealed
meaningful clinical distinctions. The mean hospital stay was
slightly shorter for the MDR group (1 ± 0.4 days) compared to
the mesh repair group (1.2 ± 0.6 days). Although operative time
was longer for the MDR technique (58.4 ± 9.2 minutes vs.
51.3 ± 10.6 minutes), early postoperative pain scores were
marginally lower (3.9 vs. 4.1), indicating a potential benefit of
10
MDR in early pain management . In another study, the average
surgical durations were recorded as 56 minutes for Lichtenstein
repair and 48 minutes for MDR; however, neither technique
significantly diminished the time required for patients to return
to work, with individuals taking up to 20 days to resume normal
activities post-intervention. Notably, the MDR was associated
with fewer postoperative complications (1.9% compared to
11.7% for the Lichtenstein repair), and no recurrences were
documented within the MDR cohort .
11
In consideration of these findings, Modified Darn Repair
emerges as a superior alternative to mesh-based techniques,
particularly in individuals with an elevated likelihood of enduring
Methodology: This randomized controlled trial was executed
at SMBBMU, Larkana (November 2022–December 2023),
encompassing 350 individuals diagnosed with inguinal hernia
(ages 18–60, either gender). Subjects were randomly allocated
to either the Modified Darn Repair (MDR) or Mesh Repair (MR)
cohorts employing the SNOSE methodology. The evaluated
outcomes comprised operative duration, postoperative
discomfort, duration of hospital stay, recovery period, and
complications. Data were subjected to statistical analysis
utilizing SPSS version 26, with statistical significance
established at p ≤ 0.05.
Objective: To compare the outcome of modified darn repair
and mesh repair in patients presenting with inguinal hernia.
Results: This study included 350 patients (186 MR, 164 MDR)
with a mean age of 33.32 ± 9.85 years (MR) and 32.34 ± 8.37
ABSTRACT
Conclusion: This investigation indicated that Modified
Darn Repair (MDR) and Mesh Repair (MR) are both effective
options for the treatment of inguinal hernia. MDR had some
benefits such as shorter hospital stays, less postoperative pain,
and lower complication rates. It is, therefore, a viable
alternative, particularly for patients with a risk of mesh-related
complications, given its lower infection and recurrence rates.
The current findings need to be confirmed in larger studies
involving multiple study centres.
years (MDR). Males constituted 90.3% (MR) and 95.7%
(MDR). Compared to MR, MDR had a shorter operative time
(38.75 ± 6.36 vs. 40.93 ± 7.31 mins, p = 0.003), lower pain
scores (3.77 ± 1.29 vs. 4.16 ± 1.57, p = 0.012), faster recovery
(15.06 ± 2.73 vs. 15.82 ± 2.93 days, p = 0.013), and fewer
complications, supporting its efficacy as an alternative
approach.
1 2 3 4
Pirha Bhatti , Monika Mankani , Tanzeela Memon , Rukhsar Kandhro
Corresponding Author
1
Pirha Bhatti
Email: [email protected]
Affiliations:
Shaheed Mohtarma Benazir Bhutto Medical University (SMBBMU),
1,4
Larkana
2,3
Gambat Institute of Medical Sciences (GIMS), Khaipur
Submitted: October 2, 2024
2
Senior Registrar
Accepted: March 11, 2025
1,3,4
Postgraduate Trainee
Revised: February 21, 2025
