REVISITING THE SHOELACE: A COMPARATIVE STUDY OF SHOELACE DARN VERSUS ONLAY MESH REPAIR IN MIDLINE INCISIONAL HERNIAS

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Background: Incisional hernia (IH) is a frequent sequel of abdominal surgery. Mesh repair is standard treatment.Abrahamson's shoelace darn is an extraperitoneal, suture-based procedure. This study compared onlay mesh hernioplasty withshoelace darn for an IH in the midline in a resource-limited rural environment. Materials and Methods: A prospectivecomparative study was done at a rural based tertiary hospital of West Bengal from 1 June 2023 till 31 May 2025. One hundredforty adults with midline IH (defect ≤10 cm on NCCT) were randomly divided into onlay mesh repair (Group A, 70 patients)and shoelace darn (Group B, 70 patients). The exclusion criteria were patients with hernias with defects >10 cm, patients withimmunosuppression and uncontrolled comorbidity, patients <18 years of age and patients >70 years of age, and patients whorefused to give informed consent. The outcomes were operative time (OT), hospital stay, surgical site infection (SSI), surgicalsite occurrence (seroma, hematoma), pain (VAS), and recurrence. Follow-up was conducted until 30 April 2026 (3,6, and 12-month follow-up). Unpaired t test was used to compare continuous variables and Chi square test was used to comparecategorical variables, p<0.05 was considered significant. Results: All the patients had swelling and dragging sensation, therewas no difference in age and sex, comorbidities, index-wound class and defect size (clinical and NCCT means ~5.4–5.5 cm).Operative time was significantly longer with shoelace darn (112.3 ± 23.4 vs 64.3 ± 17.3 min; p<0.001). There were nosignificant differences in hematoma, minor medical complications, seroma, Southampton wound scores or VAS pain or ininpatient stay (4.2 vs 4.4 days). One onlay patient had the mesh removed due to infection. At 3 months, 11.4% (onlay) vs 8.5%(shoelace) reported pain, with no one reporting pain at 6 months. There was 1 onlay patient with recurrence (1.4%) and noneafter shoelace repair (p=0.316). Conclusion: In midline IH ≤10 cm, wound outcome, pain, hospital stay and recurrence weresimilar, but shoelace darn had longer operating time. However it is still a feasible and affordable alternative in selected,economically limited patients and the art should be continued to be taught.

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