COMPARISON OF OPEN ANTERIOR MESH REPAIR AND MODIFIED OPEN ANTERIOR MESH REPAIR FOR FEMALE GROIN HERNIA

Background: Females undergoing groin hernia repair face heightened risks of occult femoral hernias and recurrence, particularly in resource-limited settings lacking laparoscopic access. This randomized controlled trial (RCT) compared the standard Lichtenstein Open Anterior Mesh repair (OAM) with a Modified Open Anterior Mesh technique (MOAM), which includes systematic transection of the transversalis fascia and femoral canal reinforcement. Methods: In a double-blinded RCT, 100 adult women (ASA I-II) with primary reducible inguinofemoral hernias were randomized to OAM (\(n=50\)) or MOAM (\(n=50\)). MOAM featured intentional exploration and mesh reinforcement of the femoral canal. Primary outcome was recurrence at 12 months; secondary outcomes included complications (Clavien-Dindo), chronic pain (Inguinal Pain Questionnaire), and patient satisfaction. Results: Ÿ Recurrence rates were comparable: 4.1% (OAM) vs. 8.0% (MOAM) (\(p=0.45\); absolute difference: \(-3.9\%\), 95% CI: \(-14.2\) to \(6.4\)). Ÿ Postoperative complications (e.g., wound morbidity, infection) showed no significant differences (\(p>0.05\)). Ÿ Chronic pain was rare (1–2%) and satisfaction high (>93%) in both groups. Ÿ Femoral hernias were identified intraoperatively in 45% of participants; 17.8% were missed without fascial transection. Conclusion: MOAM did not demonstrate superiority over OAM in reducing recurrence but enabled critical diagnosis of occult femoral hernias. Both techniques were equally safe and effective. Routine femoral canal exploration is essential in female groin hernia repair, positioning MOAM as a viable alternative in settings without advanced laparoscopy.