A Randomised Control Trial to compare Lichenstein versus Desarda technique for primary inguinal hernia repair in adolescents and young adults

Inguinal hernia is generally defined as protrusion of the contents of the abdominal cavity or preperitoneal fat through a defect in the inguinal area. Although incidence and prevalence reported in literature vary and is not precisely known, the lifetime chance of a person being operated for inguinal hernia is quiet high, 27% in men and 3% in women. As per European hernia society(EHS) guidelines published in 2009 for management of adult hernias state that Lichenstein technique or endoscopic methods should be used for repair of inguinal hernias in adults. This is in contrast to practice in paediatric population where high ligation of hernia sac is recommended. However, adolescent patients represent a “gray zone” between children and adults, and there is no consensus on the most appropriate surgery for inguinal hernias in these patients. Type of operation in these patients largely depends on the surgeon. Adult surgeons prefer to repair adolescent hernias with a mesh repair and pediatric surgeons tend to repair them with a high ligation of the sac. Although, mesh has been shown to be quite beneficial in terms of decreasing recurrence rates in inguinal hernias in adults, there are potential morbidities related to mesh use, such as chronic pain, seromas, infections, and infertility. Because of this, the avoidance of mesh may be preferable in inguinal hernia repairs in adolescents and young adults, if not at the sacrifice of increased hernia recurrence. Due to this, various mesh free tissue repair techniques have been described in literature. The most popular is the Shouldice repair technique, which is considered best among the non-mesh repair techniques with strength of recommendation level 1A. However, although the Shouldice method has recurrence rates of less than 1%, its technically demanding nature can potentially increase the incidence of recurrence of up to 15% with the less experienced and less trained hands. Therefore, other mesh free tissue repair techniques have been described throughout the literature one of which is Desarda mesh free tissue repair that was described by Dr Mohan P Desarda in 2001. The technique requires no complicated dissection or suturing, and is easy to learn as its developer claimed. Moreover, It does not require any foreign material and does not use weakened muscles or transversalis fascia for repair. Some authors have therefore concluded that the Desarda repair has the potential to become the new gold standard particularly in low-income and middle-income countries. Also, as results of Desarda technique appears promising in various studies in literature, a randomised control trial can be planned to compare this comparatively newer technique with the standard Lichtenstein technique of inguinal hernia repair, especially in adolescent and young adult population.