Comparison of tension free Desarda technique with Lichtenstein for inguinal hernia repair

Background: Inguinal hernia is common surgical problem for which mesh based technique, particularly Lichtenstein repair is considered gold standard. However it has its own limitation such as foreign body sensation, wound infection, cord fibrosis, chronic pain, etc. Desarda technique for hernia repair is emerging technique for inguinal hernia repair known for its low cost procedure, less recurrence rate and feasibility of the procedure. The objective of the study was to compare treatment of primary inguinal hernia repair with these methods in terms of various operative and post-operative parameters.Methods: 64 patients included in the study and operated after randomization. Intra-operative time, local complication, return to everyday activity, post-operative pain, foreign body sensation and early recurrence were analysed.Results: 51 patients were analysed with a minimum follow up period of 3 months and rest were lost on follow up. Operative time was less in Desarda’s repair (28.24 vs. 30.88 min). Desarda repair was cost effective, return to everyday activity was early in Desarda group, there was significantly (p<0.001) less post-operative pain measured on VAS on 2nd POD, 7th POD and 1 month. No recurrence observed.Conclusions: Desarda repair is easy to perform and takes less time to perform, it is also cost effective. Desarda repair when compared with Lichtenstein was superior in terms of postoperative pain, return to everyday activity and no foreign body sensation. Desarda repair is superior to mesh based technique in terms of outcome.

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Desarda versus Lichenstein technique for primary inguinal hernia treatment: one year results of a randomised clinical trial

International Surgery Journal ◽

10.18203/2349-2902.isj20202578 ◽

2020 ◽

Vol 7 (7) ◽

pp. 2147

Author(s):

Pinak Pani Dhar ◽

Upasana Mohanty ◽

Raman Kumar Shankar

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Foreign Body ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Foreign Body Sensation ◽

Primary Inguinal Hernia ◽

Body Sensation

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.

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Desarda’s versus Lichtenstein technique of inguinal hernia repair: a comparative study

International Surgery Journal ◽

10.18203/2349-2902.isj20194431 ◽

2019 ◽

Vol 6 (10) ◽

pp. 3719

Author(s):

Mohammad Sadik Akhtar ◽

Suraj Kant Mani ◽

Yasir Alvi ◽

Parveg Alam ◽

Syed Amzad Ali Rizvi ◽

...

Keyword(s):

Physical Activity ◽

Inguinal Hernia ◽

Foreign Body ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Foreign Body Sensation ◽

Chronic Groin Pain ◽

Body Sensation

Background: Inguinal hernias rank among the commonest of all hernias and surgery is the only definitive treatment. We analyzed the outcomes of desarda tissue based repair in comparison with the standard Lichtenstein tension free mesh repair of primary inguinal hernia.Methods: A total of 164 patients were randomly allocated into two groups, Desarda (group D) or Lichtenstein (group L) (80 VS 84, respectively). The primary outcome measures were chronic groin pain and recurrence during the follow up period. Secondary outcome measures included operating time, post-operative pain scores, duration of post-operative hospital stay, time to return to basic physical activity and to work, foreign body sensation, and post-operative complications.Results: During two year follow up, no recurrence was detected in each group. Operative time was significantly less in the Desarda group (28.91±5.82 min as compared to 34.07±8.63 min in the Lichtenstein group). Postoperative day 1, day 3 and day 7 groin pain was more in the Desarda as compared to the Lichtenstein group. Basic physical activity, chronic groin pain, cost, seroma formation, foreign body sensation, were also significantly less in the Desarda group.Conclusions: The successful primary inguinal hernia repair without mesh implantation can be achieved using Desarda tissue based repair, as it is effective as the standard Lichtenstein tension free mesh repair. Shorter operative time, early return to basic physical activity, lower cost, less chronic groin pain, less foreign body sensation are potential benefits of Desarda repair and can be preferred for inguinal hernia repair.

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A STUDY OF COMPARISON OF PURE TISSUE REPAIR (DESERDA) AND PROSTHETIC REPAIR (LICHTENSTEIN) METHODS FOR INGUINAL HERNIA REPAIR-A COMPARATIVE STUDY

10.36106/ijsr/9605824 ◽

2021 ◽

pp. 1-4

Author(s):

Harish Chauhan ◽

Daxesh Patel ◽

Nishan Gaudani

Keyword(s):

Chronic Pain ◽

Foreign Body ◽

Hernia Repair ◽

Operative Time ◽

Late Complication ◽

Normal Activity ◽

Foreign Body Sensation ◽

Prosthetic Repair ◽

Body Sensation

INTRODUCTION: An ideal hernia repair should be tension free, tissue based, with no potential damage to vital structures, no long term pain or complications and no recurrence. Although Lichtenstein's prosthetic repair is simple and safe, but it is also correlated with risk of infections, recurrence, chronic pain, testicular atrophy and infertility, foreign body sensations and chronic groin sepsis. Desarda hernia repair does not require mesh and provide more physiological support. It is simple, easy to learn. AIMS AND OBJECTIVES: a) To compare the operative time, postoperative stay and time required to return normal activity between two groups. b) To compare early complication rate and late complication rate between two groups. MATERIALAND METHODS: This observational study was conducted among patients admitted with the diagnosis of primary inguinal hernia in SMIMER, Surat. The patients were randomly allocated to either Lichtenstein or Desarda method of hernia repair. Operating time, post operative stay and duration of return to normal activity were recorded. Early complications were noted and the patients were followed up to 12 months for late complications (chronic pain, foreign body sensation, and recurrence). RESULTS: The mean operative time and postoperative stay did not show signicant differ for both groups. Patients operated by Desarda technique returned to normal activity signicantly early by 12.2 ± 2.54 days as compared to patients operated by Lichtenstein techniques (14.0 ± 2.76 days, p = 0.01). Most common early complication in both groups was pain (D group; 40.0%, Lgroup: 45.2%) followed by wound infection (D group; 8.0%, Lgroup: 6.5%) and seroma (D group; 0.0%, Lgroup: 3.2%). Occurrence of chronic pain was more in Lgroup (58.1%) as compared to D group (16.0%, p=0.001). None of the patients from D group had foreign body sensation. Foreign body sensation was observed only in ve patients of Lgroup (16.1%). Recurrence rate during one year in Lgroup (6.5%) was higher than D group (4.0%). CONCLUSION: Early return to work was potential benet of Desarda repair. Early complications were similar in both procedures. Desarda repair has lower incidence of chronic pain and foreign body sensation. However, there is no signicant difference for chronic pain in Desarda group when compared in same patients operated bilaterally with different technique. This study was conducted with small sample size with short follow up. Therefore, result of late complication in the present study may insufcient to conclude the probability of occurrence as longer follow up and larger sample size is required.

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EP.TH.444Long-term recurrence and complication rates in patients with self gripping mesh hernia repair

British Journal of Surgery ◽

10.1093/bjs/znab309.052 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Mahmoud Elnaggar ◽

Gunay Verdiyeva ◽

Nisha Rajesh Thamaran ◽

Oladapo Fafemi ◽

Alexandru Munteanu

Keyword(s):

Inguinal Hernia ◽

Foreign Body ◽

Hernia Repair ◽

Mesh Repair ◽

Foreign Body Sensation ◽

Long Term Results ◽

Recurrence Rates ◽

Body Sensation ◽

Significant Difference

Abstract Aim Assessment of long term complications of self gripping mesh used in different types of hernia repair procedures more than 4 years ago aiming to compare the results with sutured prolene mesh with regards to safety and efficacy. Methods 70 patients (3 emergency & 67 elective) ventral hernia repair procedures, done in 2016 using self gripping mesh, were followed for recurrence and complications on the long term. Results There were 2 right (6.45%) and 1 left (3.44%) inguinal hernia recurrences. There were no cases of chronic groin pain or foreign body sensation. As compared to the meta-analysis of postoperative pain using non-sutured or sutured single-layer open mesh repair for inguinal hernia, where 19 studies including 4531 patients analysed recurrence, no significant difference was found in recurrence rates between the 2 mesh repair groups after 1 year of follow-up. With regards to the incidence of chronic pain at 12 months, there was no significant difference between Self gripping and suture fixation. Conclusions The self-gripping mesh in this study has better results as compared with a sutured mesh regarding the incidence of chronic postoperative inguinal pain and foreign body sensation. Recurrence rates are comparable to most studies, however, long-term results still are based on relatively small patients numbers.

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INCIDENCE OF DELEYED RECURRENCE IN INGUINAL HERNIA REPAIR WITH POLYPROPYLENE DARN.

Journal of Saidu Medical College, Swat ◽

10.52206/jsmc.2014.4.1.458-462 ◽

1969 ◽

Vol 4 (1) ◽

pp. 458-462

Author(s):

SAMIEULLAH ◽

MANZOOR ALI ◽

AJMAL KHAN ◽

SAIFUR RAHMAN ◽

M. HUSSAIN

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Wound Infection ◽

Inguinal Hernia Repair ◽

Sampling Technique ◽

Cost Effective ◽

Posterior Wall ◽

Teaching Hospitals ◽

Poly Propylene

BACKGROUND: Inguinal Hernia is a global issue, adults with developed posterior wall of inguinalcanal needs an effective, safe, and cost effective tension free repair.OBJECTIVE: To know about the effectiveness of poly propylene darn in inguinal hernia, in terms ofdelayed recurrence.METHODS: It is a descriptive study which was conducted in Saidu Group of Teaching Hospitals;Saidu Sharif Swat From January 1999 to May 2013. Total of 386 patients collected by non probabilityconvenient sampling technique, and 390 repairs (4-patient with bilateral inguinal hernia repair) wereincluded in the study. 180 were indirect, out of these 15 were strangulated, while 210 were of directverity. 90 repairs were made under local anesthetic block, 300 were operated under general anesthesia.Our last case of the series was operated in May 2004. All the patients were discharged on either 1st or 2ndpostoperative day. 3 patients (0.76%) were readmitted for wound infection and were discharged on 8thpostoperative day. Patients were subsequently examined on day 7th and 14lh post operative day for earlycomplications and then on 6th month and yearly for 9 years, for delayed recurrence. Data were collectedon structured proforma and were analyzed on SPSS.RESULTS: Ages ranged in our study were from 20-80 years (mean of 50 years). 180 patients hadindirect hernia (46.15%), while 210 were of direct verity. Among 390 repairs 15 patients (3.8%)developed superficial wound infection, 5 patients (0.8%) established deep wound infection. 3 patients(0.76%) developed scrotal hematoma, only one case (0.25%) was re explored. 20 patients (5.18%) wentinto urinary retention and were catheterized for 24 hours. 2 patients (0.5%) developed early recurrencewith in the first year. 1 patient (0.25%) presented with hydrocele. 2 patients (0.51%) complained ofneuralgia at groin.During the long follow up for delayed recurrence we lost 58 patients (died, went abroad and some werenot willing for this follow up)among the remaining 328 patients 7 patients developed delayed recurrence2 were bilateral(2.4%). They were re operated and this time meshplasty with poly propylene meshcarried out.CONCLUSION: We concluded that Dam repair with polypropylene is safe and cost-effective, even interms of delayed recurrence of inguinal hernia, and recommend it for primary hernia repair.Key Words: Inguinal hernia, Polypropylene Dam, Delayed Recurrence.

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Comparison of self-fixating mesh with conventional polypropylene mesh in lichtenstein’s tension free inguinal hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20205884 ◽

2020 ◽

Vol 8 (1) ◽

pp. 220

Author(s):

Avinash Jose ◽

Sunil Sadanandan

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Polypropylene Mesh ◽

Operating Time ◽

Tension Free ◽

Post Operative Pain ◽

Tissue Tension

Background: Post-operative pain is a disabling complication of inguinal hernia repair. Sutures that are used to anchor the mesh are blamed for tissue tension and nerve entrapment leading to postoperative pain. Self-fixating mesh, a bicomponent mesh with resorbable polylactic acid gripping system can produce a tension-free repair without sutures, reducing the potential of post-operative pain. The objectives of the study were to compare postoperative pain, the operating time and the efficacy in terms of recurrence among patients undergoing Lichtenstein’s inguinal hernia repair with self-fixating mesh and conventional polypropylene mesh. Methods: A prospective observational study was conducted among 120 patients. Half of them underwent Lichtenstein’s inguinal hernia repair with self-fixating mesh which did not require sutures and the other half with conventional polypropylene mesh which were anchored with polypropylene sutures. Time taken to complete surgery was noted. Postoperative pain was charted using a visual analogue scale at 15 days, 3 months, 6 months and at 1 year during the follow up.Results: Median postoperative pain score and operating time was significantly lower in patients who underwent repair with self-fixating mesh. None of the patients had recurrence at the end of 1 year follow up period. Conclusions: Self-fixating mesh can reduce the postoperative pain and the operating time in patients undergoing Lichtenstein’s inguinal hernia repair when compared with a conventional polypropylene mesh. The self-fixating mesh is as efficacious as conventional polypropylene mesh in preventing recurrences.

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Evaluation of early post-operative pain and seroma formation in transabdominal pre-peritoneal (TAPP) repair of groin hernias with light weight mesh placement.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.11.3811 ◽

2020 ◽

Vol 27 (11) ◽

pp. 2279-2283

Author(s):

Maham Qazi ◽

Maria Mir Jan ◽

Junaid Zeb ◽

Muslihuddin ◽

Mohammad Zarin ◽

...

Keyword(s):

Inguinal Hernia ◽

Foreign Body ◽

Foreign Body Sensation ◽

Indirect Inguinal Hernia ◽

Light Weight ◽

Direct Inguinal Hernia ◽

Post Operative Pain ◽

Body Sensation ◽

Groin Hernias ◽

Light Weight Mesh

Objectives: To share our experience with laparoscopic surgery using TAPP technique, for groin hernias using light weight parietene mesh, to find out early post operative pain and foreign body sensation as complications. Study Design: Cross sectional study. Setting: Department of Surgery Khyber Teaching Hospital Peshawar. Period: January 2018 till August 2018. Material & Methods: A sample of 100 patients was recruited into study. All patients underwent standard transabdominal preperitonial repair with light weight Mesh. Data was collected by predesigned Performa and analyzed with SPSS 21. Results: Out of 100 patients 98% were male, 2% female, mean age was 43.2± 5.3years (minimum 17years and maximum 64years). Regarding frequency of type of hernia data showed 68% patients had indirect inguinal hernia while 32% patients had direct inguinal hernia. 65% patients had right sided inguinal hernia, 26% left sided while 9% had bilateral inguinal hernia. Post operative hospital stay showed hematoma in 5% patients, seroma in 12% patients, wound infection in 8% of patients while foreign body sensation in 4% patients. Conclusion: Most of the patients presented were of middle age. Indirect inguinal hernia was more frequent than direct inguinal hernia. Common complications apart from pain were seroma formation, hematoma, wound infection and foreign body sensation.

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

International Surgery Journal ◽

10.18203/2349-2902.isj20173407 ◽

2017 ◽

Vol 4 (8) ◽

pp. 2693

Author(s):

Probal Neogi ◽

Vivek Gupta ◽

Neeraj Tripathi

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Foreign Body ◽

Tissue Repair ◽

Tertiary Care ◽

Foreign Body Sensation ◽

Lichtenstein Repair ◽

Primary Inguinal Hernia ◽

Post Operative Pain ◽

Body Sensation

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.

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Inguinal Hernia Repair Using Self-adhering Sutureless Mesh: Adhesix™: A 3-Year Follow-up with Low Chronic Pain and Recurrence Rate

The American Surgeon ◽

10.1177/000313481608200212 ◽

2016 ◽

Vol 82 (2) ◽

pp. 112-116 ◽

Cited By ~ 3

Author(s):

Malek Tabbara ◽

Laurent Genser ◽

Manuela Bossi ◽

Maxime Barat ◽

Claude Polliand ◽

...

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Postoperative Pain ◽

Postoperative Complications ◽

Hernia Repair ◽

Inguinal Hernia Repair ◽

Recurrence Rate ◽

Initial Surgery ◽

Complications Rate

To review our experience and outcomes after inguinal hernia repair using the lightweight self-adhering sutureless mesh “Adhesix™” and demonstrate the safety and efficacy of this mesh. This is a 3-year retrospective study that included 143 consecutive patients who underwent 149 inguinal hernia repairs at our department of surgery. All hernias were repaired using a modified Lichtenstein technique. Preoperative, perioperative, and postoperative data were prospectively collected. Incidence of chronic pain, postoperative complications, recurrence, and patient satisfaction were assessed three years postoperatively by conducting a telephone survey. We had 143 patients with a mean age of 58 years (17–84), who underwent 149 hernia repairs using the Adhesix™ mesh. Ninety-two per cent (131 patients) were males. Only 10 patients (7%) had a postoperative pain for more than three years. In our series, neither age nor gender was predictive of postoperative pain. Only one patient had a hematoma lasting for more than one month and only four patients (2.8%) had a recurrence of their hernia within three years of their initial surgery. Ninety per cent of the patient expressed their satisfaction when surveyed three years after their surgery. In conclusion, the use of the self-adhering sutureless mesh for inguinal hernia repair has been proving itself as effective as the traditional mesh. Adhesix™ is associated with low chronic pain rate, recurrence rate, and postoperative complications rate, and can be safely adopted as the sole technique for inguinal hernia repair.

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