Hernia repairs are one of the most common medical conditions, affecting millions worldwide. Usually in the abdominal wall, they form when an organ or tissue protrudes through connective tissue or muscle [1]. Epigastric, incisional, femoral, umbilical, and inguinal hernias are the most common. The most common abdominal wall hernias are inguinal, at 75%. Overweight, recurrent cough, lifting heavy goods for extended durations, previous surgery, and genetic susceptibility are risk factors for the sickness [2]. It might be congenital or acquired. The biggest concerns with hernias are incarceration, strangulation, and recurrence after surgery. Even while surgery is currently the best hernia treatment, procedure choice considerably influences long-term outcomes, notably recurrence rates [3]. Mesh-based and non-mesh hernia repair technologies have evolved over time. Clinically, hernia recurrence after surgery is a major issue. To improve patient outcomes and surgical decision-making, identify recurrence factors [4]. Hernia recurrence is a major postoperative issue due to its high morbidity, surgical procedures, and healthcare costs. Studies show that surgical method, patient factors, and postoperative care affect recurrence rates [5]. Recurrence varies by

surgical method but persists despite field improvements. Traditional Shouldice and Bassini repairs without mesh heal the defect by suturing native tissues. However, this closure strains tissue, which may enhance recurrence [6]. The Lichtenstein technique and laparoscopic procedures use a synthetic or biological mesh to fortify the afflicted area, relieve strain, and promote tissue integration, reducing recurrence rates [7]. Mesh repair reduces the incidence of recurrence compared to non-mesh methods, however many are concerned about infections, chronic discomfort, and foreign body reactions [8]. Given this, it's vital to assess the two procedures' long-term recurrence, post-operative complications, and patient satisfaction. The data may help surgeons choose the optimum repair approach for each patient [9].

Prosthetic mesh has improved hernia repair success in recent decades. Mesh-based and non-mesh repairs strengthen the abdominal wall and prevent recurrence differently. Traditional mesh-free procedures suture local tissues to heal hernia defects [10]. The most common suture-based repair methods are Shouldice, Bassini, and McVay. This surgery attaches the transversalis fascia, internal oblique, and conjoint tendon to the inguinal ligament [11]. Despite its extensive use, its high recurrence rates have led to its replacement by more current treatments. This multi-layered healing method strengthens the defect by overlapping the transversalis fascia. It's better than Bassini repair, so people still do it. This procedure stitches the transverse fascia to Cooper's ligament to heal femoral hernias [12]. Non-mesh repairs avoid foreign body implantation, although suture line tension increases recurrence. Tissue ischemia from tension-based closures may hinder repair and increase hernia recurrence. Patients with infections, who refuse synthetic implants, and others who cannot use mesh insertion employ these methods.

A retrospective analysis will determine hernia recurrence rates after mesh-based and non-mesh repair techniques. The trial at Nalanda Medical College & Hospital in Patna, Bihar, will enroll 100 patients from January 2024 to December 2024. Calculate repair procedure recurrence rates using past patient data. Check the two groups for infection, pain, and foreign body reactions after surgery. To identify patient-specific characteristics including age, BMI, and co-morbidities that predict hernia recurrence. Provide data-driven hernia management guidance to improve patient care and surgery outcomes.

This study will compare mesh and non-mesh hernia repair methods over time to give information on the optimal way. By examining recurrence rates and concomitant comorbidities, surgeons can choose the optimal method for their patients, improving surgical outcomes and reducing recurring hernias. Hernia repair, a simple surgery, can substantially affect patient outcomes if done correctly.

Despite avoiding foreign body insertion, tension-based closure increases recurrence rates in non-mesh repairs. Mesh-based surgeries are stronger and have reduced recurrence rates, but they can cause persistent discomfort and mesh concerns. Given the growing relevance of evidence-based surgical decision-making, comparing the long-term effects of these two approaches is crucial. This retrospective study will reveal complications, efficacy, and recurrence rates compared to non-mesh hernia surgeries. The findings will support the hernia surgery discussion and improve clinical patient care.

This retrospective observational study compares mesh-based and non-mesh hernia recurrence rates. The study will evaluate Nalanda Medical College & Hospital in Patna, Bihar, patient records from January 2024 to December 2024. This research analyzes previous surgical cases to find trends in recurrence rates, related issues, and patient characteristics that affect surgical results. Study Design and Setting Its retrospective observational methodology allows for a complete analysis of patient data without people. This technique is appropriate for long-term surgery outcomes evaluation since it uses pre-existing data instead of actively recruiting and following up with patients. Nalanda Medical College & Hospital in Patna, Bihar, would host the study. The hospital's diverse patient population makes it ideal for hernia repair comparisons. Sample Size and Study Population 100 people who underwent hernia repairs during the trial will participate. These patients will be separated into mesh-based and non-mesh-based repair groups based on surgery. Comparing these two groups' recurrence rates helps explain each method's efficacy and long-term effects. Inclusion Criteria • Patients who underwent hernia repair surgery at Nalanda Medical College & Hospital between January 2024 and December 2024. • Patients with documented follow-up records, including recurrence status and post-operative complications. • Patients aged 18 years and older, ensuring a focus on adult hernia cases. • Patients who underwent either mesh-based or non-mesh repair techniques, allowing for a direct comparison of outcomes. Exclusion Criteria • Patients with incomplete medical records, making it difficult to assess recurrence rates. • Patients who had recurrent hernias before surgery, as their outcomes may not accurately reflect primary repair success. • Patients with complex hernias requiring additional reconstructive procedures, as these cases may introduce confounding factors. • Patients with active infections or immunocompromised conditions, which could significantly affect post-operative healing and recurrence rates. Data Collection We will collect patient data from medical records, surgical logs, and hospital follow-up notes. Demographic Data: Age, sex, BMI, health history, and any conditions that may affect surgery results. Procedure details: incisional, inguinal, femoral, or non-mesh hernia, mesh type, and open vs. laparoscopic surgery. Post-op care Duration of hospital stay, incidence of wound infections, hematomas, seroma, and persistent pain. Repeated Data Possible hernia recurrence signs, estimated time, and follow-up procedures. Standardized data collection ensures reliable patient records. The final analysis will exclude missing or partial data to maintain study reliability. Statistical Analysis Analyzing the data will use the best statistical methods. We will use the chi-square test to compare the two surgery groups' hernia recurrence rates to see if they differ statistically. When applicable, we will compare the mesh and non-mesh repair groups' time-to-recurrence rates using Kaplan-Meier survival analysis. This approach will help determine whether option is more durable. A descriptive statistical overview of the study population's demographic and clinical characteristics (mean, median, standard deviation). We can use logistic regression to predict recurrence using patient factors like age, BMI, and comorbidities. Use Fisher's exact or t-tests to compare the two groups' postoperative complications. This study uses statistical methods to compare mesh-based versus non-mesh hernia repairs. This will inform future surgical decisions by revealing the long-term success rates of the two repairs.

The results of this retrospective study are presented in tabular form, followed by detailed interpretations for each table.

Table 1: Demographic Characteristics of Patients

The data in Table 1 shows that the mean age and BMI of patients were comparable between the two groups, ensuring that differences in outcomes were not due to patient demographics.

A male predominance(75%) was observed, reflecting the higher incidence of hernias in men. The inguinal herniawas the most common type, accounting for 66% of cases, followed by incisional, umbilical, and femoral hernias.

The similar distribution of hernia types in both groups ensures comparability between the two surgical approaches.

Table 2: Surgical Details and Recurrence Rates

The findings in Table 2 indicate that mesh repair was more frequently associated with laparoscopic surgery (30%) compared to non-mesh repair (10%), which was primarily performed using open surgery. The recurrence rate was significantly lower in the mesh repair group (8.3%) than in the non-mesh repair group (30%), with a highly significant p-value (0.001). Additionally, the mean time to recurrence was longer in the mesh repair group (9.2 months) compared to the non-mesh group (6.8 months), further supporting the durability of mesh-based repairs.

Table 3: Post-Operative Complications and Hospital Stay

In Table 3, the non-mesh repair group (15%) had higher infection rates than the mesh repair group (6.7%), but the difference was not statistically significant (p=0.08). The mesh repair group had 11.7% chronic post-operative pain, compared to 22.5% in the non-mesh repair group (p-value 0.05 verging on statistical significance). Both groups produced seroma at similar rates, suggesting neither was preferable. With a p-value of 0.002, mesh repair patients had a mean hospital stay of 3.4 days compared to 4.8 days for non-mesh repair patients. This shows mesh-based repair patients heal faster and have fewer post-operative issues.

Although hernia surgery is one of the most prevalent surgeries worldwide, the debate regarding mesh or non-mesh techniques continues. We conducted this retrospective analysis at Nalanda Medical College & Hospital in Patna, Bihar, to compare the two surgical methods' recurrence rates and post-operative outcomes. The results reveal that mesh-based repair is the best surgery since it reduces recurrence and hospital stay. This section will review the relevant literature, present our findings, identify potential causes for the observed differences, discuss their treatment implications, and recognize the study's limitations.

Comparison with Existing Studies

Our results support prior study indicating mesh treatment reduces hernia recurrence. [13] Found that mesh-based tension-free hernia repairs had recurrence rates of 1-3%, compared to 10-30% for non-mesh operations. Our study indicated a recurrence rate of 8.3% in the mesh repair group and 30% in the non-mesh repair group, consistent with earlier data.

A comprehensive [14] study shown that mesh repair lasts longer than non-mesh treatments, notably for inguinal and incisional hernias.  [15] Found that the Shouldice technique and other non-mesh procedures recur more in large and severe hernias. They work for certain patients. In our study, the non-mesh repair group had shorter recurrence (6.8 months vs. 9.2 months) than the mesh repair group. This shows that mesh reinforcement gives long-term stability, especially for high-risk individuals.  Mesh implants may raise infection and chronic pain risk, according to research. The European Union Hernia Trialists Collaboration found that mesh repair increased persistent post-operative pain (12-16%) in a 2012 meta-analysis. The mesh group had 11.7% postoperative pain, while the non-mesh group had 22.5%, disproving the assumption that mesh produces increased pain over time. Different surgical procedures, patient selection criteria, and post-surgery pain management may explain these disparities.

Interpretation of Results

Mesh and non-mesh repair methods may have different recurrence rates for various reasons. The fundamental benefit of mesh reinforcement is tension-free repair by spreading stress throughout the implant instead of the suture line. However, non-mesh methods that suture native tissues are more prone to recur. This explains why the non-mesh group had a much higher recurrence rate in our study. The operation method matters too. The mesh repair group had 30% more laparoscopic surgery than the non-mesh group (10%).

The smaller incisions and less tissue stress of laparoscopic repair reduce recurrences and post-operative pain. Because open surgery is more usual in non-mesh patients, their recurrence rates may be higher. The operation's result also depends on the hernia's size, the patient's comorbidities, and BMI. Despite controlling for demographics, non-mesh surgery patients had a higher risk of incisional hernias (15% vs. 10% in the mesh group), which increase recurrence. This may have correlated with the observed results disparity.

Clinical Implications

This study has major clinical implications for surgical decision-making. Mesh hernia repairs are best because they rarely recur. This is especially true for high-risk or big anomalies. Since mesh repair reduces inpatient recovery time and post-operative care, the mesh group's shorter hospital stay (3.4 days vs. 4.8 days) suggests it may be cheaper. Therefore, each patient's needs should be considered while choosing a surgical approach. Mesh repair is beneficial, however patients with allergies, mesh infections, or extensive adhesions from earlier treatments may not benefit. When performed by qualified surgeons using the Shouldice approach, non-mesh repair may be appropriate. The study emphasises patient advice and surgeon training. Patients should know the pros and cons of both hernia repair approaches before the treatment. Patients should choose mesh repair due to its quicker recovery time and lower recurrence rate unless there are reasons not to.

Limitations

The results are noteworthy, however this study has several limitations. We cannot rule out bias in our data because our study was retrospective. Patient record inconsistencies and follow-up data availability may be problematic. Compared to large-scale, multi-center research, 100 patients is little. A larger sample improves generalizability and statistical power.

There was no random assignment to mesh or non-mesh groups, therefore patient characteristics may have affected the outcomes. Patients with complex or recurring hernias were more likely to receive mesh surgery, which may have affected outcomes. Our study's one-year follow-up may not have caught long-term recurrence rates for hernias that arise later. Research with extended follow-ups should validate these findings. Surgeons used different surgery methods, mesh types, and patient care protocols, which may have altered results. Standardizing surgical methods improves comparisons.

Researchers from Nalanda Medical College & Hospital in Patna, Bihar, compared mesh and non-mesh hernia repair success rates. The results illuminate the pros and cons of the two strategies. Mesh groups have lower recurrence rates (8.3% vs. 30%) than non-mesh groups. This suggests mesh repair is preferable. Mesh-based techniques reduce post-operative discomfort (11.7 percent vs. 22.5%) and hospital stays (3.4 days vs. 4.8 days). While non-mesh repair is a possibility, it is vital to be cautious and identify high-risk patients. This applies notably to mesh-unsuitable patients. These findings suggest that mesh repair is best for hernia procedures, especially for high-risk patients with larger defects. Mesh repair is the gold standard for hernia repairs because to its longevity, reduced strain on local tissues, and faster recovery time. For optimum results, you must carefully select patients, use proper surgical technique, and thoroughly monitor their progress after surgery. The mesh repair evidence is strong, but this study's limited sample size, retrospective methodology, and short follow-up are limitations. Future randomized controlled trials with larger patient populations and longer follow-ups should confirm these findings. Long-term studies should assess chronic pain, quality of life, and cost-effectiveness to assess mesh-based restorations. Refine surgical processes and patient selection criteria to improve hernia repair results, patient care, and surgical success.

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