Hernia repair and management Open access Peer reviewed

Comparison of Hernia Repair Using Tissue Reinforcement With the Remaining Sac Versus Polypropylene Mesh in Patients With Indirect Inguinal Hernia: A Randomised, Controlled, Double‐Blind Clinical Trial

Iman Ramezani, Mahya Aliakbari, Samaneh Tahmasebi Ghorabi, Arya Behzadi and 5 more

ANZ Journal of Surgery | Sep 16, 2026

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Both polypropylene mesh and tissue reinforcement techniques are effective and safe for indirect inguinal hernia repair, with minimal differences in outcomes.

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BACKGROUND: Indirect inguinal hernia is a common condition that often requires surgical intervention. This study compares two surgical approaches for hernia repair: tissue reinforcement using the remaining sac and polypropylene mesh repair. METHODS: A randomised, controlled, double-blind clinical trial was conducted on 132 patients aged 18-82 diagnosed with indirect inguinal hernia. Participants were randomly assigned to two intervention groups: one undergoing polypropylene mesh repair and the other using tissue reinforcement with the remaining sac. Key outcomes, including recurrence rates, postoperative complications, pain intensity, recovery time and hospital stay, were assessed at multiple intervals. RESULTS: Both techniques demonstrated comparable safety and efficacy. Recurrence rates were low in both groups (1.5% in the mesh group vs. 3% in the tissue reinforcement group, at one-year follow-up, p = 0.56). Postoperative complications, including seroma and haematoma, were identical (3% in both groups). Pain intensity (mean VAS score: 5.7 vs. 5.6, p = 0.847) and recovery time (6.7 days vs. 6.6 days, p = 0.960) were similar between the two approaches. CONCLUSION: Both polypropylene mesh and tissue reinforcement techniques are effective and safe for indirect inguinal hernia repair, with minimal differences in outcomes. Surgical decisions should be tailored to individual patient needs and clinical scenarios. These findings provide evidence supporting the flexibility of surgical approaches in managing indirect inguinal hernias. TRIAL REGISTRATION: IRCT20230410057871N3.

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Iman Ramezani

first | Education and Research Network

Mahya Aliakbari

middle | Bushehr University of Medical Sciences

Samaneh Tahmasebi Ghorabi

middle | Lorestan University of Medical Sciences | ORCID 0000-0002-6448-9664

Arya Behzadi

middle | Education and Research Network | ORCID 0000-0002-9927-8891

Bagher Mojazi Amiri

middle | Education and Research Network | ORCID 0009-0008-1842-1520

Sepideh Hadimaleki

middle | Tabriz University of Medical Sciences | ORCID 0009-0002-2826-5572

Farzad Ebrahimzadeh

middle | Lorestan University | ORCID 0000-0003-3897-8242

Masoud Sharifian

middle | Lorestan University of Medical Sciences | ORCID 0000-0002-4285-6558

Arian Karimi Rouzbahani

last | Education and Research Network | ORCID 0000-0002-0239-503X

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BibTeX

@article{Ramezani2026Comparison,
  title = {Comparison of Hernia Repair Using Tissue Reinforcement With the Remaining Sac Versus Polypropylene Mesh in Patients With Indirect Inguinal Hernia: A Randomised, Controlled, Double‐Blind Clinical Trial},
  author = {Iman Ramezani and Mahya Aliakbari and Samaneh Tahmasebi Ghorabi and Arya Behzadi and Bagher Mojazi Amiri and Sepideh Hadimaleki and Farzad Ebrahimzadeh and Masoud Sharifian and Arian Karimi Rouzbahani},
  journal = {ANZ Journal of Surgery},
  year = {2026},
  doi = {10.1111/ans.70900},
  url = {https://doi.org/10.1111/ans.70900}
}

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