Inguinal hernia repair is one of the most commonly performed surgical procedures worldwide, with millions of operations performed annually [1]. Mesh-based tension-free techniques are currently considered the standard of care for elective inguinal hernia repair because of their low recurrence rates and favorable long-term outcomes [1][2]. However, the management of complicated inguinal hernia remains distinct from elective surgery and continues to be a subject of clinical debate.

Complicated inguinal hernia includes incarcerated, strangulated, obstructed, or contaminated hernias and is frequently encountered in emergency surgical practice. These cases are associated with increased risks of bowel ischemia, resection, wound infection, and postoperative morbidity. In such situations, the use of prosthetic mesh may be contraindicated due to the increased risk of surgical site infection and mesh-related complications [1][2].

Consequently, tissue-based repair techniques remain important in the management of complicated inguinal hernia, particularly in emergency settings and resource-limited environments. The Bassini repair, first described in the nineteenth century, involves approximation of the conjoint tendon to the inguinal ligament to reconstruct the posterior wall of the inguinal canal [3]. Although historically significant, Bassini repair is a tension-based technique and has been associated with postoperative pain and delayed recovery.

The Desarda repair is a more recent tissue-based technique that utilizes an undettached strip of the external oblique aponeurosis to reinforce the posterior wall of the inguinal canal. This method provides a physiological and tension-free repair without the use of prosthetic material [4][5]. Several studies have reported favorable outcomes with this technique in both elective and emergency settings [6]-[11].

Although multiple comparative studies exist, evidence specifically evaluating Desarda versus Bassini repair in complicated inguinal hernia remains limited and fragmented. Therefore, this systematic review and meta-analysis were undertaken to synthesize available evidence comparing these two tissue-based techniques.

This systematic review and meta-analysis demonstrate that Desarda repair offers several short-term advantages over Bassini repair, including reduced postoperative pain, lower complication rates, and faster recovery. These findings are consistent with the physiological principles of the Desarda technique, which provides a tension-free repair using autologous tissue [4].

The avoidance of prosthetic material makes this technique particularly useful in contaminated or emergency settings, where mesh implantation may increase the risk of infection [1][2]. In addition, tissue-based repair may be advantageous in resource-limited environments where mesh availability is restricted.

However, several limitations should be acknowledged. The number of included studies was relatively small, and sample sizes were modest. Follow-up duration varied among studies, and long-term recurrence beyond three years remains uncertain. Larger multicenter trials with standardized outcome reporting are required.

In patients with complicated inguinal hernia where mesh implantation is contraindicated, Desarda repair appears to be a safe and effective alternative to Bassini repair. The technique is associated with improved postoperative comfort, fewer complications, and earlier functional recovery while maintaining comparable recurrence rates.