• Umberto Bracale, Paolo Melillo, Davide Piaggio, Leandro Pecchia, Diego Cuccurullo, Marco Milone, Giovanni Domenico De Palma, Giuseppe Cavallaro, Giampiero Campanelli, Giovanni Merola, and Cesare Stabilini.
• Department of Gastroenterology, Endocrinology and Endoscopic Surgery, University Federico II of Naples, Italy. Electronic address: umbertobracale@gmail.com.
• Int J Surg. 2019 Feb 1; 62: 12-21.

BackgroundCurrent guidelines state that the Shouldice technique has lower recurrence rates than other suture repairs and therefore is strongly recommended in non-mesh inguinal hernia repair. Recently a new tissue repair technique has been proposed by Desarda and studied in trials against Lichtenstein technique.MethodsThe present study was performed according to the PRISMA Statement for Network Meta-analysis and the AMSTAR 2 checklist. The method of network meta-analysis was chosen to evaluate randomized controlled trial published on tissue repair and comparing Lichtenstein respectively with Desarda and Shouldice techniques. The following parameters: operative time, recurrence, complications (general, intraoperative, Surgical Surgical Site Occurrences), VAS score on postoperative day 1, numbness, chronic pain and return to daily activities.ResultsFourteen RCTs, involving 2791 patients, fulfilled the inclusion criteria and were selected for final analysis. The anchored indirect treatment comparison showed that Desarda's technique requires a significantly shorter operative time (MD: -12.9 min; 95% CI: -20.6 to -5.2) and has a quicker recovery (MD: -6.6 days; 95% CI: -11.7 to -1.4). Outcomes concerning intraoperative complications, early postoperative pain, seroma/hematoma, hydrocele and infection rates, recurrence, numbness and chronic pain were similar among the two techniques.ConclusionsDesarda's hernia repair can be a valuable alternative to Shouldice technique for the treatment of primary inguinal hernia repair if a non-mesh technique is chosen, because of its reproducibility and quicker postoperative recovery. We recommend performing well designed prospective studies comparing both techniques directly.Copyright © 2019 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

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