Modified Desarda Technique With Double-Breasted External-Oblique Aponeurosis for Uncomplicated Inguinal Hernia—a Prospective Observational Study With Technical Refinements

Background Mesh-based repair is widely used for uncomplicated inguinal hernia, but tissue-based repair remains relevant when avoidance of prosthetic material is desired. We evaluated outcomes of a modified Desarda–Halsted repair incorporating broad posterior-wall reinforcement, double-breasting of the external oblique aponeurosis, deep-ring stabilization, and subcutaneous exteriorization of the spermatic cord. Methods A clinical series of 550 consecutive adults with uncomplicated inguinal hernia who underwent the modified repair at a tertiary surgical centre was analysed. The repair used broad external-oblique aponeurotic reinforcement, fixation around the deep inguinal ring, double-breasting of the aponeurosis, and subcutaneous positioning of the spermatic cord. The primary outcome was hernia recurrence. Secondary outcomes included postoperative complications, chronic groin pain, cord-related morbidity, and functional recovery. Results All 550 procedures were completed using the planned tissue-based technique without conversion to mesh repair. During follow-up, 4 patients developed recurrent hernia, corresponding to a recurrence rate of 0.72%. Early complications included seroma in 34 patients (6.2%), superficial surgical-site infection in 22 (4.0%), haematoma in 20 (3.6%), and transient spermatic-cord oedema in 20 (3.6%). These complications were managed conservatively. No chronic groin pain, foreign-body sensation, or persistent cord morbidity was reported. Functional recovery was favourable in the reported cohort. Conclusion The modified Desarda–Halsted repair was associated with a low observed recurrence rate and limited postoperative morbidity in this single-centre clinical series. The technique may be a mesh-free option for selected patients with uncomplicated inguinal hernia. Comparative multicentre studies with standardized outcome assessment are required to determine its effectiveness relative to established repairs.