ORIGINAL ARTICLE Comparing Lichtenstein with darning for inguinal hernia repair in an African population O. Olasehinde 1 • O. O. Lawal 1 • E. A. Agbakwuru 1 • A. O. Adisa 1 • O. I. Alatise 1 • O. A. Arowolo 1 • A. R. K. Adesunkanmi 1 • A. C. Etonyeaku 1 Received: 10 September 2015 / Accepted: 22 April 2016 Ó Springer-Verlag France 2016 Abstract Purpose Being a relatively new entrant into our practice, mesh repair has not been compared with previously exist- ing tissue-based techniques in our setting. This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-oper- ative complications, recovery and cost. Method Patients with uncomplicated, primary inguinal hernia were randomized to have their hernias repaired either by the Lichtenstein or darning technique. Details of their socio-demographic, hernia characteristics and intra- operative findings were recorded. Postoperatively patients were assessed for pain, wound site complications and recurrence. Both direct and indirect costs were calculated. Mean duration of follow-up was 7.5 months. Result Sixty-seven patients were studied. Thirty-three had Lichtenstein repair while 34 had darning repair. Lichten- stein repair was associated with less post-operative pain, less analgesic requirement, and shorter time of return to work activities, these were all statistically significant (p \ 0.05). Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest. There was no recurrence in any of the groups. Total cost was comparable between the two groups. Conclusion Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are compa- rable in terms of frequency of early post-operative com- plications and total cost. Keywords Inguinal Á Hernia Á Mesh Á Darning Á Lichtenstein Introduction Surgery for inguinal hernia has evolved since the descrip- tion of the Bassini repair [1]. The method of repair prop- agated and so named after him brought the first paradigm shift to the surgical treatment of inguinal hernia owing to its success compared to previous methods. The initial enthusiasm for the method, however, diminished over time due to a high recurrence rate encountered after some years [2]. The quest for reduction of the recurrence rate led to several modifications of the Bassini technique such as that of McVay and Shouldice. Shouldice repair has been reported to produce the good results in terms of low recurrence rates [3]. The good results in the experience of the proponents of the tech- nique has, however, not been widely reproduced by surgeons working in non-specialized centers [4, 5]. This may be due to the meticulous dissection required for the procedure thereby making it more technically challenging. The generally unsatisfactory outcome regarding recur- rence and the understanding of the role of tension in its genesis, led on to the early concept of a tension-free repair and the development of the darning technique which Moloney championed in the 1940s [6]. This technique was revised and further popularized by Abrahamson years later [7]. Very encouraging results particularly with respect to decrease in recurrence rates were reported [8]. Indeed, values as low as 1.5 % or less, which was better than most of the other tissue-based non-prosthetic repairs, were noted in certain series [9, 10]. & O. Olasehinde lekanolasehinde@yahoo.com 1 Department of Surgery, Obafemi Awolowo University Teaching Hospitals, PMB 5538, Ile-Ife, Nigeria 123 Hernia DOI 10.1007/s10029-016-1498-2