Tension free, mesh free inguinal hernia repair: a prospective study of Desarda’s technique
DOI:
https://doi.org/10.18203/2349-2902.isj20201382Keywords:
Desarda’s repair, Inguinal hernia repair, Physiological repairAbstract
Background: The Desarda repair for inguinal hernias is a new tissue-based technique. Application of the external oblique muscle aponeurosis in the form of un-detached strip has been established as a new concept in tissue-based hernia repair.
Methods: A prospective study was conducted among 126 cases with 148 inguinal hernias repaired by Desarda’s technique for a period of 3 years in Dr. B. R. Ambedkar Medical College and Hospital, Bangalore, Karnataka, India. The details pertaining to duration of hospital stay, pain, ambulation and complications were recorded.
Results: The mean age of the patients was 38.4 years. Mean operating time was 62.5 min for unilateral and 123 min for bilateral hernias. About 97.8% patients were ambulatory within 6.42 hours and were freely mobile within 19.26 hours after surgery. About 96.4% patients returned to work within 6-14 days. About 91.26% patients were discharged on same day. The mean hospital stay duration of the patients was 1.11 days. Postoperative pain on movement out of bed was described as mild and tolerable in 92.6% patients on day 1. Two patients had seroma that subsided on its own. There were no long-term complications, recurrence of the hernias or chronic groin pain.
Conclusions: The results of this new technique (Desarda repair) using continuous absorbable sutures appear promising. The continuous suturing saves time and just one packet of suture material without mesh saves cost.
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References
Williams NS, Bulstrode CJK, O’ Connell PR. Bailey & Love’s Short Practice of Surgery. London, UK: CRC press; 2013
Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):835-9.
Kingsnorth A, LeBlanc K. Hernias: inguinal and incisional. Lancet. 2003;362:1561-71.
Eklund A, Rudberg C, Smedberg S. Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguinal hernia repair. Br J Surg. 2006;93:1060-8.
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(5):984-92.
Bay NM, Perkins FM, Kehlet H. Danish hernia database pain and functional impairment 1 year after inguinal herniorrhaphy nationwide study. Ann Surg. 2001;233:1-7.
Nienhuijs SW, Oort VI, Gels ME, Strobbe LJ, Rosman C. Randomized clinical trial comparing PHS, mesh plug repair and lichtenstein repair for open inguinal hernia repair. Br J Surg. 2005;92:33-8.
Amid PK, Lichtenstein IL. Lichtenstein open tension free hernioplasty. In: Maddern GJ, Hiatt JR, Philips EH, editors. Hernia repair (open vslaparoscopic approaches). Edinburgh: Churchill Livingstone; 1997: 117-122.
Taylor SG, Dwyer PJ. Chronic groin sepsis following tension-freeinguinal hernioplasty. Br J Surg. 1999;86:562-5.
Uzzo RG, Lemack GE, Morrissey KP, Goldstein M. The effects of meshbioprosthesis on spermatic cord structures: a preliminary report in acanine model. J Urol. 1999;161:1344-9.
The MRC lap groin hernia trial group. Laparoscopic versus open repairof groin hernia: a randomized comparison. Lancet. 1999;354:185-90.
Lau H, Patil NG, Yuen WK, Lee F. Learning curve for unilateral endoscopic totally extraperitoneal (TEP) inguinal hernioplasty. Surg Endosc. 2002;16:1724-8.
Welsh DR, Alexander MA. The shouldice repair. Surg Clin North Am.1993;73:451-69.
Devlin HB, Gillen PH, Waxman BP, MacNay RA. Experience of shouldice operation 1970-1982. Br J Surg. 1986;73:123-4.
Danielson P, Isacson S, Hansen MV. Randomised study of lichtenste incompared with shouldice inguinal hernia repair by surgeons in training. Eur J Surg. 1999;165:49-53.
Desarda MP. Surgical physiology of inguinal hernia repair: a study of 200 cases. BMC Surg. 2003;3:5-9.
Anson BJ, Morgan EH, Vay CB. Surgical anatomy of the inguinal region based upon a study of 500 body-halves. Surg Gynaecol Obstet. 1960;111:707.
Desarda MP. Physiological repair of inguinal hernia: A new technique (a study of 860 patients). Hernia. 2006;10:143-6.
Williams M, Frankel S, Nanchahal K, Coast J, Donavon J. Hernia repair. In: Stevens A, Raftery J, editors. Health Care Needs Assessment. 1st ed. Oxford: Radcliffe Press; 1994.
Marshall VF. Activity and recurrent hernia. BMJ. 1977;2:3-4.
Kux M, Fuchsjager N, Schemper M. Shouldice is superior to bassini inguinal herniorrhaphy. Am J Surg. 1994;168:15-8.
Kingsnorth AN, Gray MR, Nott DM. Prospective randomized trial comparing the Shouldice technique and plication darn for inguinal hernia. Br J Surg. 1992;79:1068-70.
Kark AE, Kurzer MN, Belsham PA. Three thousand one hundredseventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. J Am Coll Surg. 1998;186:447-55.
Wasicek MC, Thirlby RC. Postoperative course after inguinal herniorrhaphy: a case-controlled comparison of patients receiving workers’ compensation vs. patients with commercial insurance. Arch Surg. 1995;130:29-32.
