Inguinal hernia repair: a comparison of strengthening the posterior inguinal wall with aponeuroplasty versus the Lichtenstein technique (mesh repair). A randomized controlled trial in a low-resource setting.

Background: Inguinal hernia repair is a frequently performed surgical procedure that generally employs prosthetic mesh. However, alternative techniques, notably the reinforcement of the posterior inguinal wall through aponeuroplasty, have not been sufficiently explored, particularly in resource-constrained environments. This study aims to evaluate and compare the efficacy and outcomes of aponeuroplasty against traditional mesh repair in adult patients with inguinal hernias.

Methods: A randomized controlled trial was conducted from April 1, 2019, to May 22, 2024, enrolling 200 adult patients diagnosed with inguinal hernias. Participants were randomized into either Group A (Lichtenstein technique with prosthetic mesh repair, n=96) or Group B (posterior inguinal wall aponeuroplasty, n=104). Patients were monitored for a minimum of two year postoperatively. The aponeuroplasty technique required meticulous dissection of the external oblique and transversus abdominis aponeuroses, ensuring tissue integrity and securing the tissue to the inguinal ligament and muscle arch. Complications, recurrence rates, and other surgical outcomes were systematically analyzed.

Results: Demographic analyses revealed no significant differences between groups. Group B demonstrated significantly shorter operative times (30 ± 9.43 min vs. 38 ± 12.55 min, p=0.004) and lower postoperative pain levels (p=0.031). Over the follow-up period of two years, hydroceles were documented in 9 patients (4.5%), with a notably lower incidence in Group B (1 case, 1.0%) compared to Group A (8 cases, 8.3%, p=0.030). Recurrence rates were similar in both groups (3 in Group A and 2 in Group B, p=0.613).

Conclusions: Strengthening the posterior inguinal wall via aponeuroplasty offers superior outcomes compared to prosthetic mesh repair, particularly regarding postoperative pain and operative time. These findings advocate for the consideration of aponeuroplasty as an effective surgical alternative for inguinal hernia repair in low-resource settings. Future studies are warranted to validate these conclusions across diverse and larger populations.