***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The main aim of this study was to evaluate outcome in patients undergoing open inguinal hernia repair with either polypropylene mesh or nylon darn Purpose Being a relatively new entrant into our practice , mesh repair has not been compared with previously existing tissue-based techniques in our setting . This study is set out to compare darning with Lichtenstein technique of inguinal hernia repair in terms of frequency of post-operative complications , recovery and cost . Method Patients with uncomplicated , primary inguinal hernia were r and omized to have their hernias repaired either by the Lichtenstein or darning technique .  Details of their socio-demographic , hernia characteristics and intra-operative findings were recorded . Postoperatively patients were assessed for pain , wound site complications and recurrence . Both direct and indirect costs were calculated . Mean duration of follow-up was 7.5 months . ResultS ixty-seven patients were studied . Thirty-three had Lichtenstein repair  while 34 had  darning repair . Lichtenstein repair was associated with less post-operative pain , less analgesic requirement , and shorter time of return to work activities , these were all statistically significant ( p < 0.05 ) . Frequency of post-operative complications was comparable in both groups with wound haematoma and scrotal oedema being the commonest . There was no recurrence in any of the groups . Total cost was comparable between the two groups . Conclusion Lichtenstein is superior to darning in terms of post-operative recovery while both techniques are comparable in terms of frequency of early post-operative complications and total cost BACKGROUND Incisional hernia is an important complication of abdominal surgery . Procedures for the repair of these hernias with sutures and with mesh have been reported , but there is no consensus about which type of procedure is best . METHODS Between March 1992 and February 1998 , we performed a multicenter trial in which we r and omly assigned to suture repair or mesh repair  200 patients who were scheduled to undergo repair of a primary hernia or a first recurrence of hernia at the site of a vertical midline incision of the abdomen of less than 6 cm in length or width . The patients were followed up by physical examination at 1 , 6 , 12 , 18 , 24 , and 36 months . Recurrence rates and potential risk factors for recurrent incisional hernia were analyzed with the use of life-table methods . RESULTS Among the 154 patients with primary hernias and the 27 patients with first-time recurrent hernias who were eligible for the study , 56 had recurrences during the follow-up period . The three-year cumulative rates of recurrence among patients who had suture repair and those who had mesh repair were 43 percent and 24 percent , respectively , with repair of a primary hernia ( P=0.02 ; difference , 19 percentage points ; 95 percent confidence interval , 3 to 35 percentage points ) . The recurrence rates were 58 percent and 20 percent with repair of a first recurrence of hernia ( P=0.10 ; difference , 38 percentage points ; 95 percent confidence interval , -1 to 78 percentage points ) . The risk factors for recurrence were suture repair , infection , prostatism ( in men ) , and previous surgery for abdominal aortic aneurysm . The size of the hernia did not affect the rate of recurrence . CONCLUSIONS Among patients with midline abdominal incisional hernias , mesh repair is superior to suture repair with regard to the recurrence of hernia , regardless of the size of the hernia Background & Objective : The inguinal hernia accounts for 50 percent in old age males . A Lichtenstein type of operation has now become the method of choice in most developed countries but in the developing world traditional simple suture repair is still in common practice in re source limited hospitals due to the scarcity and expensive nature of the commercial prosthetic mesh . Our objective was to compare the rates of complications in Lichtenstein repair to tension free Darn repair . Methods : Ninety two male patients from 20 - 60 years of age reported for direct or indirect inguinal hernia with open Mesh/Lichtenstein or darn repair in emergency or electively from January 2014 to December 2015 were enrolled in this prospect i ve r and omized control trial ( RCT ) . The primary end point was to compare the surgical site infection , length of hospital stay and hernia recurrence with different techniques . Results : The hospital stay was higher in patients who had Lichtenstein repair  , Superficial surgical site infections in cohort A ( 6.5 % ) and cohort B (4.36%)were noted . Complications of recurrence in Group-A were ( 1.5 % ) as compared to Group-B which had a recurrence of 6.52 % . Conclusion : Lichtenstein is more promising in comparison to Darn repair in terms of recurrence in inguinal hernia Non-r and omised studies of the effects of interventions are critical to many areas of healthcare evaluation , but their results may be biased . It is therefore important to underst and and appraise their strengths and weaknesses . We developed ROBINS-I ( “ Risk Of Bias In Non-r and omised Studies - of Interventions ” ) , a new tool for evaluating risk of bias in estimates of the comparative effectiveness ( harm or benefit ) of interventions from studies that did not use r and omisation  to allocate units ( individuals or clusters of individuals ) to comparison groups . The tool will be particularly useful to those undertaking systematic review s that include non-r and omised studies The optimum method for inguinal hernia repair has not yet been determined . The recurrence rate for non‐mesh methods varies between 0·2 and 33 per cent . The value of tension‐free repair with prosthetic mesh remains to be confirmed . The aim of this study was to compare mesh and non‐mesh suture repair of primary inguinal hernias with respect to clinical outcome , quality of life and cost in a multicentre r and omized trial in general hospitals Purpose The aim of this study was to evaluate whether modified darn repair ( MDR ) is comparable to Lichtenstein procedure ( LP ) in the treatment of primary inguinal hernia , regarding chronic postoperative pain and recurrence . Methods Two hundred and twenty-seven male patients with primary inguinal hernia were r and omly allocated into two groups : group I included 108 patients [ mean age 37.47 ± 11.97 years ] who were subjected to  MDR  and group II that included 119 patients [ mean age 37.44 ± 11.93 years ] who were subjected to LP . Results Recurrence was encountered in only one case after LP . Visual Analog Scale showed significant more early and late postoperative pain after LP compared to MDR . The operative time for LP [ 72.99 ± 19.90 min ] was significantly shorter compared to MDR [ 78.53 ± 12.76 min ] . Both MDR and LP showed no significant differences as regards hospital stay [ 1.04 ± 0.19 days vs. 1.09 ± 0.28 days ] , time to return to domestic activity [ 1.18 ± 0.43 days vs. 1.15 ± 0.36 days ] , time to return to work activity [ 6.84 ± 1.09 vs. 6.67 ± 0.94 days ] , early and late postoperative complications . Conclusions After 1-year follow-up , MDR as a tension-free repair seems comparable to LP with less postoperative pain 
    Output:
    
The evidence was inconclusive for chronic pain .
Conclusions Our results suggest that open darn repair is comparable with open mesh repair  for inguinal hernias .
Considering that consequences of mesh complications in inguinal hernia repair , albeit rare , can be significant , open darn repair provides an equally credible alternative to open mesh repair for inguinal hernias .