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Background: The ideal operation to treat inguinal hernia is still far to define. The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to European Hernia Society guidelines. Desarda’s technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda and mesh-based Lichtenstein techniques.Methods: A total of 42 participants (40 males and 2 females) were randomly assigned to the Desarda (group 1) and Lichtenstein (group 2), 19 vs 23 respectively. The primary outcomes measured were recurrence (for maximum follow up of 1 year and minimum of 5 months) and chronic pain. Additionally, operative time, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12 months after surgery.Results: During the follow-up, one recurrence was observed in Desarda group after 10 months of surgery. Chronic pain was experienced by 10.5% and 8.7% of patients from groups Desarda and Lichtenstein respectively. Foreign body sensation and return to activity were comparable between the two groups. Operative time was less in Desarda group. There was significantly less seroma production in the Desarda group.Conclusions: The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 1 year follow up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.
ABSTRACT
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.
ABSTRACT
Background: Various techniques for treatment of inguinal hernia have been studied. The use of a mesh is costly and has its own complications. In Desarda’s technique- external oblique muscle aponeurosis is placed in the form of an undetached strip for inguinal hernia repair. The objective of this study is to compare the outcomes of Lichtenstein’s repair versus Desarda’s technique.Methods: In this prospective study, 50 patients with inguinal hernia were enrolled at A. J. Institute of Medical Sciences and Research centre. 25 patients each were divided into two groups by randomization and were operated using Lichtenstein’s hernioplasty and Desarda’s technique. Patients were assessed for cost effectiveness, operation time, postoperative pain, hospital stay, foreign body sensation, return to non-strenuous activity, complications and recurrence rate in the postoperative period on day 1, 3, 5, 1 month and 6 months.Results: With regards to pain, foreign body sensation and duration of surgery Desarda’s repair was better than Lichtenstein’s repair (p<0.05). Mean hospital stay in Desarda’s group was comparable to the Lichtenstein group (p=0.16). Return to normal non-strenuous activity after 7-15 days in Desarda was 80% and 64% in Lichtenstein. No case of recurrence or chronic groin pain in either group was found.Conclusions: Based on the result, reduced cost of treatment, lesser post-operative pain and no mesh related complications authors can conclude that Desarda’s technique is equally effective as Lichtenstein’s repair for inguinal hernia and can consider it as the method of choice in treating inguinal hernia.
ABSTRACT
INTRODUCCIÓN. Con el presente trabajo se buscó dar respuesta a algunas controversias en torno de la reparación de las hernias inguinales, así como realizar una valoración sobre el dolor posoperatorio y analizar los costos de las técnicas de reparación protésicas y la técnica que refuerza la pared posterior del canal inguinal con una franja aponeurótica pediculada del músculo oblicuo mayor. MÉTODOS. Se realizó un estudio prospectivo aleatorio de 836 pacientes con hernia inguinal, operados entre septiembre del 2001 y diciembre del 2007. A un grupo se le practicó una hernioplastia anterior con malla y al otro la técnica de Mohan P. Desarda, la cual consiste en una herniorrafia sin malla. RESULTADOS. Ambos grupos de pacientes fueron comparables, sin diferencias con respecto a la edad, la localización y el tipo de hernia. El tiempo quirúrgico fue menor en la hernioplastia con malla y no hubo diferencias significativas en cuanto al dolor durante el primer y tercer día del posoperatorio, pero en el grupo de la hernioplastia éste fue superior al quinto día. En tres pacientes hubo rechazo a la malla de polipropileno. CONCLUSIONES. La técnica de Desarda, al no utilizar malla, fue más económica que la hernioplastia con malla; esta diferencia fue estadísticamente significativa(AU)
INTRODUCTION: With present paper we gave response to some controversies around the repair of inguinal hernias as well as to make a valuation on postoperative pain and to analyze the costs of prosthetic repair techniques and the technique reinforcing the posterior wall of inguinal channel with a pediculate aponeurotic band of major obliquus muscle. METHODS: A random prospective study was conducted in 836 patients presenting with inguinal hernia, operated on between September, 2001 and December, 2007. A group underwent anterior hernioplasty with mesh and in the other we used Mohan P. Desarda technique, which is a herniorrhaphy without mesh. RESULTS: Both groups of patients were comparable without differences regarding age, localization and type of hernia. Surgical time was lesser in mesh hernioplasty and without significant differences regards pain during the first and third postoperative days, but the group with hernioplasty the time was superior at fifth day. In three patients there was a polypropylene mesh rejection. CONCLUSIONS: Desarda's technique without mesh was more economic than mesh hernioplasty; this difference was statistically significant(AU)