Is Desarda technique suitable to emergency inguinal hernia surgery? A systematic review and meta-analysis

BACKGROUND: Despite the fact that Lichtenstein is the gold standard for uncomplicated inguinal hernia, the use of mesh in an emergency context remains controversial. Pure tissue repairs have an essential role in the management of incarcerated or strangulated inguinal hernia. To date, there has been little agreement on what is the best surgical technique suitable for emergency hernia surgery. This systematic review aims to evaluate the efficacy and safety of the pure tissue Desarda technique for emergency inguinal hernia repair. METHODS: A complete search of electronic databases including PubMed/Medline, Web of Science, Embase and, Cochrane library was realized. Newcastle-Ottawa-Scale (NOS) (selection and outcome criteria) was used for quality assessment of included studies. The pooled prevalence of post-operative complications (surgical site infection, hematoma/seroma, chronic pain and, recurrence rate) was estimated. RESULTS: We included 5 studies from different countries. There were 2 randomized controlled trial and 3 observational cohort studies. Totally, there were 199 patients with a mean age of 57.6 years. Male patients were predominant (n = 196). The pooled prevalence of surgical site infection and hematoma/seroma was respectively 16.56% (95% CI: 11.74–22.39) and 12.43% (95%CI: 6.90–20.108). The pooled prevalence of chronic pain and recurrence was respectively 4.35% (95% CI: 1.04–11.47) and 2.10% (95%CI: 0.61–5.14). CONCLUSIONS: In summary, Desarda technique is feasible in emergency context with good results. We found any particularly important rate of complications considering the surgery in emergency context. Further studies should be realized to raise the level of evidence.