DOI: http://dx.doi.org/10.18203/2349-2902.isj20173407

A comparative study of outcomes of Lichtenstein repair and Desarda tissue repair in patients of inguinal hernia

Probal Neogi, Vivek Gupta, Neeraj Tripathi

Abstract


Background: Inguinal hernia is a very common surgical problem for which, mesh-based techniques, particularly the Lichtenstein repair is considered standard. However, problems like foreign body sensation, wound infection, cord fibrosis, chronic pain and recurrence are major concern. Desarda tissue repair (non-mesh technique), which was given by an Indian surgeon, is now being used in many countries because of low cost of procedure with very low recurrence rates. The objective of this study was to evaluate the feasibility of Desarda tissue repair at a tertiary care centre of Central India as a treatment of primary inguinal hernia, by comparing it with Lichtenstein repair in terms of various post-operative parameters.

Methods: Patients between age of 18 and 70 years with primary inguinal hernia were included in this randomised controlled trial. Patients with strangulated, obstructed or recurrent hernia, surgically unfit patients and patients having unmanaged urinary obstruction, cough or constipation were excluded. Randomization was done by sealed envelope method into Lichtenstein and Desarda arm and respective surgeries were performed.

Results: 90 patients were included in the study and average duration of follow-up was 15.1 months. Operative time was significantly less in Desarda arm (14.75 min compared to 21.32 min in Lichtenstein arm). Cost, incidence of seroma formation, post-operative pain, foreign body sensation and chronic pain were also significantly less in Desarda arm. No recurrence was observed in both arms.

Conclusions: Desarda repair is easy to perform and takes less time to perform and proves cost effective. Desarda repair is comparable to Lichtenstein repair in terms of many parameters and superior in terms of post-operative pain and foreign body sensation and can be preferred for young patients. In infected and strangulated cases, Desarda repair can be used effectively without fear of mesh infection.


Keywords


Chronic pain, Desarda tissue repair, Inguinal hernia, Lichtenstein repair, Recurrence

Full Text:

PDF

References


Kingsnorth A, Giorgobiani G, Bennett DH. Hernias, Umbilicus and Abdominal wall. In: Williams NS, Bulstrode CJK, O'connell PR eds. Bailey and Love's short practice of Surgery. London: Arnold; 2008:968-990.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J, et al. European Hernia Society guidelines on the treatment of Inguinal Hernia in adult patients. Hernia. 2009;13(4):343-403.

Fitzgibbons RJ, Forse RA. Clinical practice. Groin hernias in adults. N Engl J Med. 2015;372(8):756-63.

Desarda MP. Surgical physiology of Inguinal Hernia repair - a study of 200 cases. BMC Surg. 2003 3:2.

Desarda MP, Ghosh DN. Comparative study of open mesh repair and Desarda's no mesh repair in a district hospital in India. East Central Afr J Surg. 2006;11(2):18-34.

Liem MS, van Duyn EB, van der Graaf Y, van Vroonhoven TJ. Coala trial group. Recurrences after conventional anterior and laparoscopic inguinal hernia repair: a randomized comparison. Ann Surg. 2003;237(1):136-41.

Shin D, Lipshultz LI, Goldstein M, Barmé GA, Fuchs EF, Nagler HM, et al. Herniorrhaphy with polypropylene mesh causing inguinal vasal obstruction: a preventable cause of obstructive azoospermia. Ann Surg. 2005;241(4):553-8.

Robinson TN, Clarke JH, Schoen J, Walsh MD. Major mesh-related complications following hernia repair: events reported to the Food and Drug Administration. Surg Endosc. 2005;19(12):1556-60.

Chung, Lucia PS. Abdominal wall hernias: symptoms and outcome. MD thesis, 2014. Available at http://theses.gla.ac.uk/5168/.

Sigterman TA, Gorissen KJ, Dolmans DE. Fasciitis necroticans after elective hernia inguinal surgery. Case Rep Surg. 2014;2014:981262.

Narita M, Moriyoshi K, Hanada K, Matsusue R, Hata H, Yamaguchi T, et al. Successful treatment for patients with chronic orchialgia following Inguinal Hernia repair by means of meshoma removal, orchiectomy and triple-neurectomy. Int J Surg Case Rep. 2015;16:157-61.

Al-Subaie S, Al-Haddad M, Al-Yaqout W, Al-Hajeri M, Claus C. A case of a colocutaneous fistula: A rare complication of mesh migration into the sigmoid colon after open tension-free hernia repair. Int J Surg Case Rep. 2015;14:26-9.

Desarda MP. Inguinal Herniorrhaphy with an undetached strip of external oblique aponeurosis: a new approach used in 400 patients. Eur J Surg. 2001;167:443-8.

Desarda MP, Ghosh DN. Comparative study of open mesh repair and Desarda's no mesh repair in a district hospital in India. East Central Afr J Surg. 2006;11(2):18-34.

Desarda MP. No-mesh Inguinal Hernia repair with continuous absorbable sutures: a dream or reality? A study of 229 patients. Saudi J Gastroenterol. 2008;14:122-7.

Losanoff JE, Millis JM. Aponeurosis instead of prosthetic mesh for Inguinal Hernia repair: neither physiological nor new. Hernia. 2006;10(2):1981-99.

Naguib N, Samerraai AE. No-mesh inguinal hernia repair with continuous absorbable sutures: is it a step forward or backward? Saudi J Gastroenterol. 2009;15(1):67-8.

Manyilirah W, Kijjambu S, Upoki A, Kiryabwire J. Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for Inguinal Hernia repair among black African patients: a short-term double-blind RCT. Hernia. 2012;16(2):133-44.

Youssef T, El-Alfy K, Farid M. Randomized clinical trial of Desarda versus Lichtenstein repair for treatment of primary Inguinal Hernia. Int J Surg. 2015;20:28-34.

Abbas Z, Bhat SK, Koul M, Bhat R. Desarda's no mesh repair versus lichtenstein's open mesh repair of inguinal hernia a comparative study. J Evolut Med Dent Sci. 2015;4(77):13279-85.

Brown CN, Finch JG. Which mesh for hernia repair? Ann R Coll Surg Engl. 2010;92(4):272-8.

Dilek ON. Hernioplasty and testicular perfusion. Springer Plus. 2014;3:107.