Chakraborty 2007.
| Methods | Two‐hundred and forty (240) participants were randomised to either receive a 'darn' suture repair (120) or have a 'mesh' inserted (120). Participants were reviewed during their postoperative period (up to 1 month) and at 1, 3, 6, 9, 12, and 18 months upon discharge. | |
| Participants | Any male who had an unilateral inguinal hernia, which were nonobstructive, reducible, and either primary or recurrent. Those who presented with bilateral inguinal hernias, or complications including obstruction, strangulation or significant irreducibility were excluded form this study. | |
| Interventions |
"Darn" group In the "darn" group, participants received a 3‐layered darn repair using 1‐0 prolene sutures over a 2‐0 prolene bed. "Mesh" group In the "mesh" group, participants received a prolene mesh secured with 2‐0 prolene sutures. All participants received general and local anaesthesia, and a prophylactic dose of cefuroxime briefly preoperatively. |
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| Outcomes |
Peri‐post‐operative follow‐up within 1 month
Follow‐up at 1, 3, 6, 9, 12 and 18 months (note: only total results at the 18 month endpoint published)
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| Notes | In summary, this study concluded that mesh repair is on par (that is, no better or worse) when compared with the traditional darn suture repair; both groups recorded no recurrences to date, and postoperative complications were minimal in both arms. This study was conducted in India, a low‐income nation, and whilst the study authors empathised with the contemporary view that mesh technique is increasing in popularity, it remains costly, especially for those in low‐income nations seeking early treatment; whereby, a well constructed darn suture is an equally effective and less costly treatment option for inguinal hernias according to this study. | |
| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Low risk | Reported the use of a closed‐box system where names where names were randomly drawn out in sealed envelopes; of which there were equal number of envelopes for either groups. An impartial person unrelated to the study was employed to draw the participants out of the box and to ensure that baseline demographics of participants in both groups were equally matched prior to confirming the allocations. |
| Allocation concealment (selection bias) | Low risk | Selected based on standardised inclusion (and exclusion) criteria as described in the participants section above; participants were examined by three experienced impartial clinicians which were unrelated to the study or its authors. Allocations were delivered by a sealed envelope. |
| Blinding of participants and personnel (performance bias) All outcomes | Unclear risk | There was no information in the published journal of the study regarding attempts at blinding either the participants or personnel assessing outcomes. |
| Blinding of outcome assessment (detection bias) All outcomes | Unclear risk | There was no information in the published journal of the study regarding attempts at blinding either the participants or personnel assessing outcomes. |
| Incomplete outcome data (attrition bias) All outcomes | Unclear risk | There is no mention if any participants had failed to follow‐up, nor is there any confirmation that there was a zero attrition rate. The discussion of the results is based on the assumption that no one has dropped out over the 18 months. |
| Selective reporting (reporting bias) | High risk | This study may have an agenda to portray mesh and non‐mesh techniques on par with another due to cost concerns in a low‐income nation. Interestingly, the study has failed to include cost as one of its outcome measures and there are concerns regarding sufficient follow‐up regarding its participants. |
| Other bias | Low risk | No other significant biases were noted. |