DOI: http://dx.doi.org/10.18203/2349-2902.isj20192371

Outcome of Desarda repair in incarcerated inguinal hernia repair: experience in university hospital

Avtar Pachauri, Awanish Kumar

Abstract


Background: Synthetic mesh based hernia repair is usually avoided in contaminated and dirty inguinal hernia repair to minimize the risk of infection. Desarda’s technique is a tissue based inguinal hernia repair method which avoids the use of prosthetic mesh. So this study was conducted with the aim to observe the outcome of Desarda’s technique in incarcerated inguinal hernia repair as an alternative procedure to mesh repair.

Methods: This study was conducted in Emergency surgery department KGMU Lucknow. Total 30 patients with incarcerated inguinal hernia were included. Patients with recurrent hernia were excluded. Desarda repair was done in all patients. Patients were followed for 1 year to assess the outcome.

Results: The mean age was 52±3 years. Mean operative time was 55±5 mins. Total duration of hospital stay was 4-16 days. Mild to moderate pain observed more frequently on 3rd and 7th post-operative day. Complication rates were found to be SSI (6%), seroma (3%), and recurrence (3%). Time taken to return to daily basic and work activities was 3 (3-5) and 15 days respectively. Patients’ subjective assessment of foreign body sensation done at 6th and 12th month follow up was found in 16% and 13% cases and that of abdominal wall stiffness in 23% followed by a reduction of upto 16% cases by 12th month.

Conclusions: Desarda’s method is a safe, effective technique and may potentiate the use of tissue based repair for treating incarcerated, contaminated inguinal hernia repair. It has very low rate of recurrence and low cost of treatment.


Keywords


Desarda’s repair, Incarcerated hernia, Inguinal hernia repair

Full Text:

PDF

References


Kingsworth A, Bennet DH. Hernia, Umblicus: abdominal wall. In: Russell RCG, Williams NS, Bulstrode CJK. Bailey and Love Short Practice of Surgery. 23rd Ed. London: Arnold; 2000:1149.

Genc V, Ensari C, Ergul Z, Kulacoglu H. A very late-onset deep infection after prosthetic inguinal hernia repair. Chirurgia (Bucur). 2010;105:555-7.

Jeans S, Williams GL, Stephenson BM Migration after open mesh plug inguinal hernioplasty: a review of the literature. Am Surg. 2007;73:207-9.

Benedetti M, Albertario S, Niebel T, Bianchi C, Tinozzi FP, Moglia P, et al. Intestinal perforation as a long-term complication of plug and mesh inguinal hernioplasty: case report. Hernia. 2005;9:93-5.

Losanoff JE, Richman BW, Jones JW. Inguinal herniorrhaphy with an undetached strip of external oblique aponeurosis:old or new? Eur J Surg. 2001;167:877.

Morgan M, Reynolds A, Swan AV, Beech R, Delvin HB. Are current techniques of inguinal hernia repair optimal? A survey study in the United Kingdom. Ann R Coll Surg Engl. 1991;73(6):341-5.

CDC. Surgical Site Infection (SSI) Event. https://www.cdc.gov/nhsn/pdfs/pscmanual/9pscssicurrent.pdf. Accessed on 31 December 2017.

Desarda MP. New method of inguinal hernia repair: A new solution. ANZ J Surg. 2001;71(4):241-4.

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. New method of inguinal hernia repair: a new solution. ANZ J Surg. 2001;71:241-4.

Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z. Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg. 2012;36:984-92.

Hussain A, Mehsam S, Ali M, Rasul S, Parveen S, Memon A. Emergency inguinal hernia repair: comparison of Desarda’s versus darning technique. J Ayub Medical College Abbottabad. 2017;29(4):551-3.

Bashir SH, Afzal MO, Rafi YA. Desarda Technique for Inguinal Hernia Repair, a multicenter experience. Pak J Med Health Sci. 2015;9(1):311.

Pandey H, Thakur DS, Somashekar U, Kothari R, Agarwal P, Sharma D. Use of polypropylene mesh in contaminated and dirty strangulated hernias: short-term results. Hernia. 2018;22(6):1045-50.

Mariette C, Wind P, Lupinacci RM, Tresallet C, Adham M, Arvieux C, et al. Practice patterns in complex ventral hernia repair and place of biological grafts: a national survey among French digestive academic surgeons. J Visceral Surg. 2014;151(1):9-16.

Cross W, Kumar A, Chandru Kowdley G. Biological mesh in contaminated fields-overuse without data: a systematic review of their use in abdominal wall reconstruction. Am Surg. 2014 Jan 1;80(1):3-8.

Rosen MJ, Bauer JJ, Harmaty M, Carbonell AM, Cobb WS, Matthews B, et al. Multicenter, prospective, longitudinal study of the recurrence, surgical site infection, and quality of life after contaminated ventral hernia repair using biosynthetic absorbable mesh: the COBRA study. Annals Surg. 2017;265(1):205.

D'Ambrosio R, Capasso L, Sgueglia S, Iarrobino G, Buonincontro S, Carfora E, et al. The meshes of polypropylene in emergency surgery for strangulated hernias and incisional hernias. Ann Ital Chir. 2004;75:569–73.

Junge K, Rosch R, Klinge U, Schwab R, Peiper CH, Binnebösel M, et al. Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia. 2006;10(4):309-15.

Youssef T, El-Alfy K, Farid M. Randomized clinical trial of Desarda versus Lichten stein repair for treatment of primary inguinal hernia. Inter J Surg. 2015;20:28-34.

Rodríguez P, Herrera PP, Gonzalez OL, Alonso JR, Blanco HS. A Randomized Trial Comparing Lichtenstein Repair and No Mesh Desarda Repair for Inguinal Hernia: A Study of 1382 Patients. East and Central African J Surg. 2013;18(2):18-25.