Background
The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the 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 (D) and mesh-based Lichtenstein (L) techniques.

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Desarda Versus Lichtenstein Technique for Primary Inguinal Hernia Treatment: 3-Year Results of a Randomized Clinical Trial

Purpose
This study compared the short-term outcomes of the non-mesh (Desarda) and mesh (Lichtenstein) methods of hernia repair among Black African patients, with regard to acute postoperative pain, day of return to normal gait, operative time and complications.

Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT

Background/Aim: The author has published results from two series based on his new technique of inguinal hernia repair. Interrupted sutures with a nonabsorbable material were used for repairs in both theses series. The author now describes the results of repairs done with continuous absorbable sutures. Materials and Methods: This is a prospective study of 229 patients having 256 hernias operated from December 2003 to December 2006. An undetached strip of the external oblique aponeurosis was sutured between the inguinal ligament and the muscle arch to form the new posterior wall. Continuous sutures were taken with absorbable suture material (Monofilament Polydioxanone Violet). Data of hospital stay, complications, ambulation, recurrences, and pain were recorded. Follow-up was done until June 2007. Results: A total of 224 (97.8%) patients were ambulatory within 6-8 h (mean: 6.42 h) and they attained free ambulation within 18-24 h (mean: 19.26 h). A total of 222 (96.4%) patients returned to work within 6-14 days (mean: 8.62 days) and 209 (91.26%) patients had one-night stays in the hospital. A total of 216 (94.3%) patients had mild pain for 2 days. There were four minor complications, but no recurrence or incidence of chronic groin pain. Patients were followed up for a mean period of 24.28 months (range: 6-42 months). Conclusions: The results of this study correlate well with the author's previous publications. Continuous suturing saves operative time and one packet of suture material. The dream of every surgeon to give recurrence-free inguinal hernia repair without leaving any foreign body inside the patient may well become a reality in future.

No-mesh Inguinal Hernia Repair with Continuous Absorbable Sutures: A Dream or Reality? (A Study of 229 Patients)

Background Inguinal hernia repair is the most common general surgical procedure in industrialized countries, with a frequency of about 200 operations per 100 000 persons per year. Suture- and mesh-based techniques can be used, and the procedure can be either open or minimally invasive. Methods This review is based on a selective search of the literature, with interpretation of the published findings according to the principles of evidence-based medicine. Results Inguinal hernia is diagnosed by physical examination. Surgery is not necessarily indicated for a primary, asymptomatic inguinal hernia in a male patient, but all inguinal hernias in women should be operated on. For hernias in women, and for all bilateral hernias, a laparoscopic or endoscopic procedure is preferable to an open procedure. Primary unilateral hernias in men can be treated either by open surgery or by laparoscopy/endoscopy. Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery. A mesh-based repair is generally recommended; this seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix. Conclusion The choice of procedure has been addressed by international guidelines based on high-level evidence. Surgeons should deviate from their recommendations only in exceptional cases and for special reasons. Guideline conformity implies that hernia surgeons must master both open and endoscopic/laparoscopic techniques.

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Evidence-Based Hernia Treatment in Adults.

Background: The first author has described a new technique of pure tissue hernia repair and published his results previously 1,2 . This article describes the results of a comparative study of this new technique and the open mesh repair done in a district level general hospital set up in India. Methods: This is a retrospective study of 269 hernias operated by the author’s technique and 225 hernias operated by the mesh repair during a period from April 1998 to December 2003. Data of hospital stay, intra-operative complications, ambulation, pain, and postoperative early and late complications were recorded and compared using SSPS software. Results: The mean stay in the author’s technique was 1.22+/-0.89 days while it was 3.59+/-1.93 days in the mesh group. The mean time to return to work in the author’s technique was 8.48+/-2.43 days while it was 12.46+/-2.11 days in the mesh group. There were 5 complications in the author’s technique while there were 16 complications in the mesh group. There was no recurrence seen with the author’s technique while there were 4 recurrences in the mesh group (1.97%). In addition there were 3 patients in the mesh group who underwent reoperation for chronic debilitating groin pain (1.47%). At the end of 1 year there were 13 /203 patients (6.49%) who had chronic groin pain while there was no incidence of chronic groin pain in the author’s technique. 234(92.8%) patients in author’s group and 171(84.3%) patients in mesh group were followed up for a median follow up period of 4.1 and 3.9 years respectively (Range 1-5 years). Conclusions: The results of the new repair described by the author look very promising. This repair has minimal complications and no recurrence. This operation is based on the physiological principle and this concept of physiological repair of inguinal hernia needs to be studied worldwide. This new repair has the potential to become the gold standard of hernia repair in years to come.

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Comparative study of ppen mesh repair and Desarda’s no-mesh repair in a District Hospital in India

The author has developed a new operation technique based on the physiological principle that provides dynamic posterior wall for inguinal hernia repair. Results of the first series of 400 patients were published in 2001 (ANZ J Surg 71:241–244, 2001). Now the author has described the results of the second series of 860 patients having 920 hernias with follow-up for more than 7 years. An undetached strip of the external oblique aponeurosis (EOA) is sutured to the inguinal ligament below and the muscle arch above, behind the cord, to form a new posterior wall. External oblique muscle gives additional strength to the weakened muscle arch to keep this strip physiologically dynamic. In this prospective study, 920 inguinal hernia repairs were performed between August 1990 and December 2003 in 860 patients. Follow-up was done for 7 years. The main outcome measure was early and late morbidities and especially recurrence in a long-term follow-up. Mean patient age was 50.5 years (range 18–90). A total of 851 (98.95%) patients were operated under local or regional anesthesia; 838 (97.4%) patients were ambulatory with limited movements in 6 h and free movements in 18–24 h; 792 (92%) patients had a hospital stay of one night and 840 (97.6%) patients returned to normal activities within 1–2 weeks. Hematoma formation requiring drainage was observed in one patient, while seven patients had wound edema during the postoperative period which subsided on its own. Follow-up was completed in 623 patients (72.5 %) by clinical examination or questionnaire. The median follow-up period was 7.8 years (range 1–12 years). There was no recurrence of hernia or postoperative neuralgia. This operation is simple to perform, does not require foreign body like a mesh or complicated dissection of the inguinal floor as in Bassini/Shouldice. It has shown excellent results with virtually zero recurrence rates.

Physiological repair of inguinal hernia: a new technique (study of 860 patients)

The aim of the present review study was to compare the outcomes of non-mesh Desarda technique with open mesh, Bassini and Lap repairs for inguinal hernia over a period of last 20 years. An internet search for RCTs/comparative studies comparing outcomes between Desarda and other repairs like open mesh, Bassini and Lap repairs were done. Search for individual studies was also conducted. RCT/comparative studies and individual non comparative studies comprising 35578 patients were found in search. All those published articles were downloaded from the internet. Some articles were directly obtained from the authors. Outcomes of these articles were evaluated and compared for recurrence, chronic pain, complications, free mobility, return to normal work and cost. A total number of 80 RCTs/comparative studies and 53 individual studies were included in this review with total number of 35578 patients. Recurrence 0.87% versus 5.6%, chronic pain 1.8% versus 22.5%, complications 6.87% versus 20.6%, free mobility 37.6 hours versus 77.2 hours, return to normal work 10.2 days versus 16.7 days and cost $40.8 versus $68.5 was seen in Desarda versus other repairs, respectively. Desarda repair showed much superior results over other repairs like open mesh, Bassini or Lap repairs in terms of recurrence, chronic pain, complications, free mobility, return to normal work and the cost.

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M. P. Desarda

Papers

Physiological repair of inguinal hernia: a new technique (study of 860 patients)

Desarda repair versus other inguinal hernia repairs: a review of global data of 35578 patients