MROP-Mesh versus Desarda technique for short-term surgical outcomes in open inguinal hernia repair at Kampala International University Teaching-Hospital: A randomized controlled trial
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Date
2021-07
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Kampala International University
Abstract
Introduction: Surgical outcomes of open Inguinal hernia repairs dictate the best technique to use and tension free repair is the current standard of care. Mesh repair and Desarda techniques are tension free techniques and their outcomes are comparable. The dearth of data comparing affordable mesh and Desarda techniques limits choice in developing countries. This study compares short term surgical outcome of open inguinal hernia repair of MROP mesh with Desarda techniques. Methods: The study adopted a double blinded randomized clinical trial at KIUTH that followed up 66 Males aged 18-65 years with primary inguinal hernia who were recruited and randomly assigned to M-arm (32) and D-arm(34) for open inguinal hernia repair for 14 days for surgical outcomes. Data was recorded using a questionnaire and analysed by Stata 14 . The difference in mean operative time, pain scores-(VAS) and complications were compared using unpaired-student t-test, Fisher’s exact, Mann-whitney(U) and Kruskal-Wallis(H) tests as appropriate. The study was approved by KIU-REC-(Nr.UG-REC-023/202020), UNSCT (UNCST/RC1/94812205) and Clinical trial registry-(PACTR202105846681553). Results: The mean age of 66 males was 46±11 years, 4 years greater in M-arm and majority were illiterate (74.8%). There were risks of familial hernia (36.4%), smoking and alcohol (38%), moderate pain and average long duration of inguinal swelling of 83 months. The mean operative time (minutes) was longer for M-(M=60.78, SD=22.93) than D (M=51.44, SD =30.36) with a variance of 9.3 and p = 0.16 indicating no statistical significance between the two arms. There was moderate pain (D=2.86±0.4,𝑀 = 2.87 ± 0.4) for first two days and mild to no pain at day 7 and 14. while many had acute pain (D-arm 80%, M-arm 74%), 5% (M) had haematoma, scrotal swelling (D=6%, M=18%), and only 2 (3.0%) respondents had surgical site infection with majority 53-(D=49%, M=47%) returning to work by end of day 14 follow up. Conclusion: There was no statistically significant difference in mean operative duration, pain, immediate and intermediate complications, and quality of life after hernioplasty between Desarda and Mesh repair. The null hypothesis of this study is henceforth accepted. Recommendation: Desarda-technique and MROP-mesh should be adopted as standard of care in hernia surgery in low-income countries.