Abstract / Summary
Background The management of complicated inguinal hernias in emergency settings remains challenging, particularly when bowel compromise precludes safe mesh placement. The Desarda technique, a mesh-free repair using the external oblique aponeurosis, has shown promise, but long-term outcomes beyond one year are limited. This study evaluated the safety, effectiveness, and three-year outcomes of the Desarda technique for complicated inguinal hernia repair. Methods This prospective cohort study included 150 male patients aged >14 years who underwent Desarda repair for complicated (irreducible, incarcerated, or obstructed) inguinal or inguinoscrotal hernias between August 2022 and July 2025 at Minia University Hospital, Egypt. A total of 178 patients were assessed for eligibility; 28 patients (15.7%) were excluded intraoperatively due to a thin, separated, or markedly weakened external oblique aponeurosis unsuitable for Desarda repair (defined by thickness <0.5 mm, fenestrations, or inability to hold sutures). Primary outcome was 3-year recurrence rate. Secondary outcomes included operative time, hospital stay, recovery metrics, complications, and chronic pain. Data were analyzed using descriptive statistics and Kaplan-Meier survival analysis. Results Mean operative time was 66.50 ± 9.98 min; mean hospital stay was 2.10 ± 0.82 days. Return to basic, home, and work activities occurred at 2.30 ± 1.33 , 7.10 ± 2.25 , and 21.20 ± 6.93 days, respectively. Early complications included seroma (7.3%), hematoma (3.3%), groin pain (4.7%), and surgical site infection (1.3%). The overall 30-day complication rate was 11.3% (17/150). No orchitis or testicular atrophy occurred. At three years, follow-up was complete in 142 of 150 patients (94.7% retention). Cumulative recurrence rate was 2.8% (4/142). Chronic groin pain (persisting >6 months) occurred in 2.1% (3/142). All recurrences occurred within the first 18 months. In the obese subgroup (BMI ≥30, n = 74, 49.3%), recurrence was 2.7% (2/74) and complication rates were comparable to the overall cohort, supporting the feasibility of the Desarda technique in high-BMI patients. Conclusion The Desarda technique is a safe and effective mesh-free option for complicated inguinal hernia repair, with low early complications, rapid recovery, and a durable 3-year recurrence rate of 2.8%. It should be considered a valuable alternative in resource-limited and contaminated-field settings, or when mesh-related complications are a concern, with the choice of repair individualized based on patient factors and clinical context.