INTRODUCTIONInguinal hernia is one of the most common diseases manage by surgeon.1 A hernia is abnormal protrusion of a viscus or a part of viscus through an opening in the wall of cavity containing it. It tends to occur at natural areas of weakness, where muscles are not strong and are vulnerable to intra-abdominal pressure. The estimated lifetime risk for inguinal hernia is 27% for men and 3% for women. 2The choice of a surgery depends on the surgeon as there were no written surgical guidelines for hernia treatment till 2009. [3][4][5] There is a considerable variation in the efficiency of all these procedures which is calculated by the rate of recurrence, complications which is also influenced not only by the different techniques but also by experience and the technical skills of the surgeons. 6 However, the ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent ABSTRACT Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda's repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country. Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, postoperative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences. Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda's technique was 2.5 days while it was 2.6 days in Lichtenstein's group. The mean time to return to basic physical activity in the Desarda's technique was 12.6 days while it was 13.3 days in the Lichtenstein's group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein's group. Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, postoperative pain, complications and recurrence, between Desarda's technique and Lichtenstein's technique. However chronic inguinal pain is less in Desarda's technique. Desarda's repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

INTRODUCTIONLichtenstein was first to coin the term "tension-free hernioplasty" in his book "Hernia repair without disability".1 All direct, indirect and recurrent adult hernias can be repaired by this procedure. The most important of all advantages of the Lichtenstein repair is the dramatically low recurrence rate, ease of operative technique and low infection rate.2 But Wantz warns in his study titled as "Experience with tension-free hernioplasty for primary inguinal hernias in men" that though this procedure produces excellent results, the prolene mesh does not cover the entire myopectineal orifice (MPO) and therefore is inadequate to prevent a femoral hernia. He also states that incomplete covering of MPO by the mesh may in future predispose to direct herniation from below ABSTRACT Background: Lichtenstein was first to coin the term "tension-free hernioplasty" in his book "Hernia repair without disability". All direct, indirect and recurrent adult hernias can be repaired by this procedure. The objective of this study was to determine the feasibility of using the prolene (polypropylene) hernia system for open tension-free repair on inguinal hernias. Methods: During period of 2 years, 42 patients were subjected to prolene hernia. Of these 42 patients, 3 patients underwent bilateral repair. Thus, in all 45 inguinal hernias were repaired. The median age of patients in our study was 57 years. In our study majority hernias were indirect inguinal hernias (47.61%). Nineteen (45.23%) hernias were of direct type while 2 (4.76%) pantaloon and 1 recurrent inguinal hernias. Out of the 42 patients, 16 were operated under local anesthesia while 17 patients operated under spinal anesthesia. Maximum hernias were Gilbert's type III hernias. Results: The duration of surgery averaged 35 min (range 20-90 min). There were no postoperative deaths. Two out of 42 patients developed local infection at wound site. Wound seroma was found in 3 patients but subsided by giving antibiotics and patients were discharged as per routine protocol. 2 patients (4.76%) developed mild pain in testicular region which subsided with non-steroidal anti-inflammatory drugs. One patient (2.38%) in our series had pain in operative region that lasted for more than one month, only non-steroidal analgesics sufficed to deal with this problem and no patient complained of pain after 2 months of surgery. No patient in our series developed late infection or testicular atrophy. No recurrence was noted during the period of follow-up. This was consistent with the result of other series performed worldwide. Most of the patients in our study (18 patients i.e. 42.87%) were discharged on 3rd postoperative day. One patient had mild neuralgia up to maximum of 2 months in the follow up period which subsided with analgesics. No recurrence was seen in the follow up period. Conclusions: The prolene hernia system is a novel approach in the management of inguinal hernias, with encouraging initial results. Its long-term efficacy needs to be studied with larger, prospective double...