A narrative review of Desarda repair technique in strangulated and obstructed inguinal hernias

Strangulated and obstructed inguinal hernias represent time-sensitive surgical emergencies associated with increased morbidity, risk of bowel resection, surgical site infection, prolonged hospitalization, and potential mortality if not treated promptly. While mesh-based techniques remain the gold standard for elective inguinal hernia repair due to reduced recurrence rates, their role in contaminated or potentially contaminated operative fields remains debated. Prosthetic mesh implantation in emergency settings may increase the risk of infection and mesh-related complications, particularly when bowel resection is involved. The Desarda repair, a pure tissue-based, mesh-free technique utilizing an undetached strip of the external oblique aponeurosis for posterior wall reinforcement, has emerged as a feasible alternative in emergency cases. This narrative review critically evaluates the surgical principles, anatomical rationale, available clinical evidence, advantages, limitations and current role of Desarda repair in strangulated and obstructed inguinal hernias. A structured literature search was conducted in PubMed, Google Scholar, and Semantic Scholar using the keywords “desarda repair,” “emergency hernia surgery,” “incarcerated hernia,” “obstructed hernia,” “strangulated hernia,” “darning repair” and “lichtenstein repair.” Clinical trials, observational studies, case series, systematic reviews and meta-analyses were included. Studies evaluating laparoscopic or robotic emergency hernia repair, duplicate study, articles lacking relevant data were excluded. The retrieved evidence was analysed using a narrative synthesis approach. The Desarda tissue-based inguinal hernia repair appears to be a safe and effective procedure for emergency cases with low recurrence rates (0–7.7%) and modest chronic pain rates (1.6–4.4%). SSI and seroma/hematoma rates are variable (SSI 6– 19.4% hematoma/seroma 3 –19.3%). Existing data in emergency population represent highly acceptable short and mid-term outcomes, suggesting the feasibility of Desarda repair in emergency inguinal hernia surgery but robust, high-quality randomized trials in emergency populations remain limited. Further prospective, multicenter studies are required to establish its definitive in emergency hernia surgery.