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Absorbable suture material in non-mesh inguinal hernia repair: a narrative review of Shouldice, Bassini, and Desarda
Christoph Paasch1,2, Reiko Wiessner3, Ralph Lorenz2,4
1Department of Surgery, Shouldice Hospital, Markham, Canada.
Background:
Tissue-based inguinal hernia repair is traditionally performed with non-absorbable sutures or wire. Interest exists in absorbable sutures, particularly long-term materials. This review summarizes evidence as a basis for potential future pilot studies in non-mesh techniques aiming to reduce foreign body load.
Methods:
A narrative literature review was conducted between October 2025 and January 2026 using a structured and transparent search strategy. Four investigators independently searched PubMed/MEDLINE for clinical studies on non-mesh inguinal hernia repair using absorbable sutures. Eligible studies were qualitatively synthesized, and levels of evidence were assessed using the Oxford Centre for Evidence-Based Medicine (OCEBM) classification. The search included title and abstract terms for Shouldice, Bassini, and Desarda.
Results:
Sixteen studies (1983-2023) were included, comprising randomized trials, prospective studies, and one registry analysis. In Shouldice Repair, recurrence ranged from 0.5% to 8.9% with 3-31 months follow-up, while registry data (9-year follow-up) showed increased reoperation risk versus non-absorbable sutures. Bassini repair using short-term absorbable sutures showed recurrence rates of 3.3% to 20%. Desarda repair demonstrated low recurrence rates (0-2.4%), particularly with long-term absorbable materials. Heterogeneity was substantial across design, materials, follow-up, and outcomes. Follow-up duration and reporting were inconsistent, limiting comparability and meta-analysis.
Conclusion:
Available evidence indicates that absorbable sutures in established tissue-based inguinal hernia repair are associated with higher recurrence and cannot currently be recommended, particularly for Shouldice and Bassini repair. However, reducing permanent foreign body load remains important. Future research should focus on long-term or ultra-long-term absorbable sutures and hybrid approaches to enable durable, mesh-free repair without permanent foreign material.
