Desarda’s versus Lichtenstein’s mesh repair for inguinal hernia: A longitudinal study.

Objectives: To compare the tissue based Desarda repair with Lichtenstein mesh technique for inguinal hernia in terms of operation time, hospital stay, return to normal activities, cost and post-operative complications such as seroma formation, surgical site infection and recurrence. Study Design: Randomized Controlled trial. Setting: Department of General Surgery Hayatabad Medical Complex, Peshawar, Pakistan. Period: June 2017 to June 2019. Material & Methods: Total of 150 male patients were selected using Non probability consecutive sampling technique. Patients were randomized into two groups using lottery method. 75 patients in group A underwent hernia repair with Desarda no mesh technique and 75 patients in group B underwent hernia repair by performing Lichtenstein mesh technique. Patients were followed up after 2 weeks, 1 month, 3 months, 6 months and 1 year. Data was evaluated using version 22 of SPSS and expressed as a standard deviation, mean. Independent-sample T test was used to compare continuous variables. Categorical variables were compared using Fischer’s exact test. P value of less than 0.05 was considered significant. Results: The mean age of Desarda group was 44.59±10.58 years while it was 44.44±10.30 years in the Lichtenstein group (P=0.932).Mean Operative time was less for Desarda repair (42.08 ± 3.42 min) when compared to Lichtenstein repair (49.01 ± 4.77min) (p=0.000). The average hospital stay after Desarda repair was 2.08±0.27 days and after Lichtenstein repair it was 3.00±0.40 days (p=0.000). After Desarda procedure the average duration to return to work was 11.10±2.32 days while it was 13.92±2.24 days in Lichtenstein procedure (p<0.0001). The total cost of the operation was (Rs 3893±293) in Desarda group and (Rs 7844±175) in the Lichtenstein group (p=0.000). When compared for observed postoperative complications like seroma, wound infection and recurrence in both groups all the p-values were > 0.05 and were non-significant statistically. Conclusion: In comparison to Lichtenstein mesh repair, Desarda technique is cost effective, easy to learn, patients have less hospital stay, less chances of post-operative complications and early return to basic physical activities However Desarda technique is not possible in patients having thin external oblique aponeurosis with divided fibers and here Lichtenstein technique is better option. Further long term randomized control trials are required on large-scale to evaluate this technique further.

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Desarda’s versus Lichtenstein technique of inguinal hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20175553 ◽

2017 ◽

Vol 5 (1) ◽

pp. 92

Author(s):

Obaid Syed

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Complication Rate ◽

Mesh Repair ◽

Post Operative Pain ◽

Significant Difference ◽

Duration Of Surgery ◽

Operative Complications ◽

The Mean

Background: Ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent achieves this entire goal. The Lichtenstein mesh repair is associated with complications, postoperative dysfunction and high cost composite meshes. Desarda's technique, became a new surgical option for tissue-based inguinal hernia repair. The present study was designed to evaluate and compare the effectiveness and complications of the Desarda’s repair with Lichtenstein tension-free mesh repair for treatment of inguinal hernia in a developing country.Methods: 200 patients with unilateral, primary, reducible inguinal hernia were selected. Included patients were randomly divided into two groups. Studied parameters were Duration of surgery, intra operative complications, post-operative Pain, Duration of hospital stay, return to normal activities, post-operative complications and recurrences.Results: There were a total of 100 patients each group. There was no statistically significant difference in duration of surgery and complication rate between the two groups. Difference in mean VAS was not statistically significant. The mean hospital stay in Desarda’s technique was 2.5 days while it was 2.6 days in Lichtenstein’s group. The mean time to return to basic physical activity in the Desarda’s technique was 12.6 days while it was 13.3 days in the Lichtenstein’s group. There were no recurrences in either group. Chronic inguinal pain (>1month) was more frequent in Lichtenstein’s group.Conclusions: There is no significant difference in duration of surgery, intra operative complication rate, post-operative pain, complications and recurrence, between Desarda’s technique and Lichtenstein’s technique. However chronic inguinal pain is less in Desarda’s technique. Desarda’s repair must be considered in young patients (<30 years). Its long-term efficacy needs to be studied with larger, prospective double-blind randomized trials, with longer follow-up.

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Post-Operative Outcome of Desarda Repair of Inguinal Hernia in Emergency Case in Bangladesh

Journal of Current and Advance Medical Research ◽

10.3329/jcamr.v7i1.46430 ◽

2020 ◽

Vol 7 (1) ◽

pp. 44-48 ◽

Cited By ~ 1

Author(s):

SM Iftekhar Uddeen Sagar ◽

SM Nazrul Islam ◽

Md Abul Kalam Azad ◽

Mohammad Khaleduzzaman Khan ◽

Muhammad Mofazzal Hossain ◽

...

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Groin Pain ◽

Operating Time ◽

Early Recurrence ◽

Chronic Groin Pain ◽

Post Operative Pain ◽

Operative Complications ◽

Post Operative Complications

Background: Desarda hernia repair has emerged as a recognized operative method for inguinal hernia repair. Objective: The purpose of the present study was to see the outcome of emergency inguinal hernia repair by Desarda technique. Methodology: This was an observational study was carried out in the Department of Surgery at Sher-E-Bangla Medical College Hospital, Barisal, Bangladesh and Private Hospital, Narayanganj, Bangladesh from August 2015 to January 2017. Twenty patient was operated by Desarda technique. Variables includes age, operating time, post-operative complications, post-operative hospital stay, cost of the procedure, chronic groin pain and any early recurrence. Result: Mean age of patient 50.25±18.9, Mean operating time was 78.4±9.64 mins. Majority 16 patient experienced mild post-operative pain measured in VAS score. Mean with SD of hospital stay was 5.05±2.16 days. Patient had developed different post-operative complications like wound infection in 2(10.0%) cases, scrotal edema in 5(25.0%) cases, seroma formation in 1(5.0%) case and no early recurrence and. Conclusion: In this study, it revealed that Desarda repair was associated with less post-operative complications, less post-operative pain, zero recurrence rate, no chronic groin pain and performed in emergency cases. So it is safe and most reliable technique for complicated (Incarcerated, Obstructed, Strangulated) inguinal hernia. Journal of Current and Advance Medical Research 2020;7(1): 44-48

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Repair of inguinal hernia by Desarda technique in both elective and emergency setting

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v45i3.44649 ◽

2019 ◽

Vol 45 (3) ◽

pp. 180-184

Author(s):

S.M. Iftekhar Uddeen Sagar ◽

Muhammad Syeef Khalid ◽

Abu Sayeed Md. Feroz Mustafa ◽

SM Nazrul Islam

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Operating Time ◽

Chronic Groin Pain ◽

Post Operative Pain ◽

Operative Complications ◽

Post Operative Complications

Background: Inguinal hernia is a common problem and its repair is one of the most commonly performed procedures in general surgical practice. Several methods have been developed including Lichtenstein’s repair. Among these Lichtenstein’s repair has been standard technique for last few decades. In recent time a new procedure “no mesh Desarda hernia repair” has emerged as a recognized operative method for inguinal hernia repair. Objectives: This study was conducted to evaluate the outcome of Desarda technique in repairing inguinal hernia. Methods: This was a single centered descriptive study to see the outcome of inguinal hernia repair by Desarda technique in both elective and emergency surgery carried out in the Dept. of Surgery, Sher-E-Bangla Medical College Hospital, Barisal from August, 2015 to July, 2016. Results: A total of 100 patients underwent Desarda repair for inguinal hernia including primary/recurrent and elective/ emergency cases. Variables includes age, type of surgery, operating time, post-operative complications, post-operative pain, post-operative hospital stay, cost of the procedure, chronic groin pain and any early recurrence. Mean age of patient was 48.9±9.07 years. Mean operating time was 43.72±9.64mins. Majority (54%) of the patient experienced mild post-operative pain on first day, measured in VAS score. Ten percent of patients developed different post-operative complications like wound infection (2%), seroma formation (1%) and scrotaledema (7%). Conclusion: In this study, it is revealed that no mesh Desarda repair for inguinal hernia was associated with less operating time, less post-operative pain, less post-operative complications, short hospital stay, zero recurrence rate, no chronic groin pain and performed in emergency cases also. So, it is safe and most reliable technique for all type of inguinal hernia surgery.

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Status of self-medication among the patients attending outpatient department in selected private hospitals in Dhaka city

Bangladesh Medical Research Council Bulletin ◽

10.3329/bmrcb.v45i3.44650 ◽

2019 ◽

Vol 45 (3) ◽

pp. 185-190

Author(s):

Md. Riyadh Hasan ◽

Nawzia Yasmin ◽

Nuhad Raisa Seoty ◽

Md. Maniul Hasan ◽

Maj. Gen. (Retd) Dr. M Shahjahan

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Groin Pain ◽

Operating Time ◽

Chronic Groin Pain ◽

Post Operative Pain ◽

Operative Complications ◽

Post Operative Complications

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Primitive Isolated Hydatid Cyst of the Spleen: Total Splenectomy Versus Spleen Saving Surgical Modalities

10.21203/rs.3.rs-72769/v1 ◽

2020 ◽

Author(s):

Atef Mejri ◽

khaoula Arfaoui ◽

Mohamed Firas Ayadi ◽

Badreddine Aloui ◽

Jasser Yaakoubi

Keyword(s):

Hydatid Cyst ◽

Hospital Stay ◽

Surgical Techniques ◽

Case Series ◽

Surgical Approaches ◽

Average Hospital ◽

Spleen Preserving ◽

Operative Complications ◽

Total Splenectomy ◽

Post Operative Complications

Abstract BackgroundThis study aims to describe the clinical features of the isolated primitive splenic hydatid cyst, discuss and compare the different surgical approaches of this uncommon disease.MethodsThis is a descriptive retrospective study carried out over a period of 7 years extended from January 2013 until December 2019 reporting eight cases of isolated primitive splenic localization of hydatid disease. Data were collected from the register of the general surgery department of the Jendouba regional hospital. Files concerning another associated hydatid localization were excluded. Four patients underwent total splenectomy and four of them underwent different spleen preserving surgical techniques including resection of the protruding dome, partial splenectomy and pericystectomy.ResultsThe discovery of the pathology was incidental in 50% of cases, while pain in the left upper quadrant of the abdomen and renitent mass in the same quadrant revealed the pathology only in 25% and 12,5% respectively . None of patients who underwent total splenectomy had fever or sings of postoperative sepsis. Compared to those who had total splenectomy, patients who underwent spleen preserving surgery had a longer average hospital stay ( 9 vs 6,25 days) related to post-operative complications including abscess in the residual cavity after protruding dome resection in one patient and post-operative haemorrhage in one patient. ConclusionsThe current case series argues in favor of total splenectomy, preferably by laparoscopic route whenever the technical platform allows it, associated with some specific peri-operative therapeutic measures, as the safest way that helps to avoid post-operative complications of spleen saving surgical modalities. These complications are usually difficult to manage in poor countries with limited technical resources. Total splenectomy guarantees at least a decreased hospital stay, reduced healthcare costs, and the absence of recurrence in highly endemic underdeveloped countries.

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Robotic Inguinal Hernias Performed at a Community Hospital: a Case Series of 292 Patients

Surgical Technology Online ◽

10.52198/21.sti.39.hr1510 ◽

2021 ◽

Vol 39 ◽

Author(s):

Matthew McGuirk ◽

◽

Ziad Abouezzi ◽

Zubair Zoha ◽

Abbas Smiley ◽

...

Keyword(s):

Inguinal Hernia ◽

Postoperative Complications ◽

Hernia Repair ◽

Learning Curve ◽

Community Hospital ◽

Early Recurrence ◽

Operative Complications ◽

The Mean ◽

Robotic Inguinal Hernia Repair ◽

Post Operative Complications

Background: Robotic inguinal hernia repair has become more common and has replaced the laparoscopic approach in many hospitals in the US. We present a retrospective review of 416 consecutive inguinal hernia repairs using the robotic transabdominal preperitoneal approach in an academic community hospital. Methods: This is a retrospective review of 416 consecutive robotic inguinal hernia repairs in 292 patients performed from October 2015 to March 2021 by two surgeons. The demographics, intra-operative findings, and postoperative outcomes were analyzed. The results for patients during the initial 25 cases (which were considered to be during the learning curve for each surgeon) were compared to their subsequent cases. A multivariable logistic regression analysis was used to determine independent risk factors for postoperative complications. Results: Overall, 292 patients underwent 416 inguinal hernia repairs, of whom 124 (42.5%) had bilateral hernias. The mean age was 61 years and the mean BMI was 26.96 kg/m2. Of the bilateral hernias, 31.5% were unsuspected pre-operatively. Femoral hernias were found in 20.5% of patients, including in 18.4% of men, which were also unsuspected. Post-operatively, 89% of patients were discharged home the same day. The most common post-operative complication was seroma, which occurred in 13%. Three patients required re-intervention: one had deep SSI (infected mesh removal), one had a needle aspiration of a hematoma (SSORI), and one was operated on for small bowel volvulus related to adhesions. On short-term follow-up, there was only one early recurrence (0.2%). When cases during the learning curve period were compared to subsequent surgeries, there were no major differences in post-operative complications or operating time. Patients aged ≥55 years had a 2.456-fold (p=0.023) increased odds of post-operative complications. Conclusions: Robotic inguinal hernia repair can be safely performed at a community hospital with few early post-operative complications and very low early recurrence rates. The robotic approach also allows for the detection of a significant number of unsuspected contralateral inguinal hernias and femoral hernias, especially in male patients. Age ≥55 years was an independent risk factor for postoperative complications.

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A COMPARITIVE STUDY OF ONLAY – SUBLAY MESHPLASTY (PHS) vs. LICHTENSTEIN MESHPLASTY OF INGUINAL HERNIA

10.36106/ijar/8602229 ◽

2021 ◽

pp. 56-58

Author(s):

Chenna Dharma Kishore Raja ◽

Sreerama Raja

Keyword(s):

Inguinal Hernia ◽

Hernia Repair ◽

Return To Work ◽

Hospital Stay ◽

Mesh Repair ◽

Age Distribution ◽

P Value ◽

Tension Free ◽

Duration Of Surgery ◽

Type Of Surgery

Introduction: A Hernia is the protrusion of part of the abdominal contents beyond the abdominal wall's normal connes. In this study, an attempt is made to compare the results of two different modalities of hernia repair–Lichtenstein repair and repair of hernia with Polypropylene hernia system. Aim: The study aims to ascertain the Polypropylene hernia system's safety and benets for hernia repair against conventional Lichtenstein tension-free mesh repair technique. Materials and methods: The prospective clinical study comprises 30 patients presenting with inguinal hernia attending OPD and admitted to the General Surgery Department of King George Hospital, Visakhapatnam, during the study period of September 2018 to October 2020. Results: Age distribution between 10-90, most of the 50-70 age group (14 cases). Visual analog scale (VAS) score for PMR 4.55 ± 1.18 and LMR 6.06 1.27 (p-value <0.05). Wound infection for PMR 1 case and LMR 2 cases. Duration of surgery for PMR 65.40 ± 7.84 and LMR 51.33 ± 13.51 (p-value <0.05). Type of surgery and duration of hospital stay for PMR 4.93 ± 1.27 LMR 6.73 ± 2.12. Type of surgery and return to work for PMR 5.93 ± 1.27 and LMR 7.73 ± 2.12(p-value <0.05).Recurrence in PMR 0 % and LMR 6.67%. Conclusion: PHS repair is superior to Lichtenstein mesh repair about safe, tension-free method, shorter hospital Stay, early return to work, least recurrence rates, and a high subjective success rate and satisfaction rate.

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Post-operative complications and pain comparison between modified Bassini’s repair and Lichtestein’s hernioplasty in inguinal hernia repair

International Surgery Journal ◽

10.18203/2349-2902.isj20210367 ◽

2021 ◽

Vol 8 (2) ◽

pp. 579

Author(s):

Sunil Kumar ◽

Sreenivasa .

Keyword(s):

Chronic Pain ◽

Inguinal Hernia ◽

Hernia Repair ◽

Randomized Study ◽

Detailed Examination ◽

Randomised Study ◽

Significant Difference ◽

Operative Complications ◽

Mesh Hernioplasty ◽

Post Operative Complications

Background: Bassini’s repair and the Lichtenstein’s tension free mesh hernioplasty are commonly used hernia repair techniques and yet there is no uniform opinion as to which is the best technique. This study was undertaken to compare the postoperative complications so as to determine the best suitable of the two procedures.Methods: A comparative randomized study was conducted on a total of 80 patients reporting to our hospital with inguinal hernia and were subjected to detailed examination, operated upon by either of technique and followed up. The post operative complications & pain were observed, analyzed and compared with other similar studies.Results: In this randomised study pain after 12 and 24 hours was significantly less in the Lichtenstein’s group when compared with Modified Bassini’s repair. However there was no significant difference at 36 hours. Chronic pain after 1, 3 & 6 months was also not significant.Conclusions: The Lichtenstein’s hernioplasty was comparatively better than Modified Bassini’s repair due to its simplicity, less dissection, lesser complications & lesser early pain and chronic pain in our study.

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A COMPARATIVE AND RANDOMIZED STUDY BETWEEN TRANS ABDOMINAL PRE-PERITONEAL VERSUS TOTALLY EXTRA-PERITONEAL LAPAROSCOPIC TECHNIQUES OF INGUINAL HERNIA REPAIR

10.36106/ijsr/6207373 ◽

2020 ◽

pp. 26-29

Author(s):

Nikhil Agrawal ◽

Swapnil Sen

Keyword(s):

Inguinal Hernia ◽

Postoperative Pain ◽

Hernia Repair ◽

Hospital Stay ◽

Inguinal Hernia Repair ◽

Operative Time ◽

Length Of Hospital Stay ◽

Statistical Hypothesis ◽

Categorical Variables ◽

Chi Squared

A hernia, an abnormal protrusion of an organ or tissue through a defect in its surrounding wall is a very common surgical problem. Approximately 75% of all hernias are usually groin hernias, among which 95% are inguinal region hernias. Various methods of repair have been employed which have progressed from open repair to various laparoscopic approaches. There is insufficient data to draw conclusions about the relative effectiveness of the two laparoscopic methods. Overall superiority of the two laparoscopic methods has not been demonstrated in available literature. AIM: The purpose of this study is to compare the clinical effectiveness and relative efficiency of laparoscopic TAPP and laparoscopic TEP for inguinal hernia repair. MATERIALS AND METHODS: Hospital based comparative randomised study on 100 patients admitted in General Surgical wards with Inguinal hernia at a tertiary care centre of Eastern India. Randomization in two groups was done by lottery system. A well designed proforma containing various parameters under study was used for data collection. Baseline information were collected via structured interview using predesigned questionnaire. For statistical analysis data were entered into a Microsoft excel spreadsheet and then analyzed by SPSS version 24 and GraphPad Prism version 5. Data had been summarized as mean and standard deviation for numerical variables and count and percentages for categorical variables. Two-sample t-tests for a difference in mean involved independent samples or unpaired samples. Paired t-tests were a form of blocking and had greater power than unpaired tests. A chi-squared test (χ2 test) was any statistical hypothesis test wherein the sampling distribution of the test statistic is a chi-squared distribution when the null hypothesis is true. Unpaired proportions were compared by Chi-square test or Fischer’s exact test, as appropriate. RESULTS: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP. Visceral injury and vascular injury were found more in TAPP as compared to TEP but this was not statistically significant. Seroma, port site hernia, persisting numbness and mesh/deep infection was higher in group-A (TAPP) as compared to group-B (TEP) but this was not statistically significant. Conversion to open procedure and persistent pain were comparable among the two methods. Hernia recurrence rates were higher in the TEP group in this study although it was statistically insignificant. CONCLUSION: TAPP was associated with significantly higher incidence of haematoma, length of hospital stay, early postoperative pain and longer operative time as compared to TEP.

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Laparoscopic transabdominal preperitoneal inguinal repair versus open Lichtenstein repair: a randomized control trial

International Surgery Journal ◽

10.18203/2349-2902.isj20175522 ◽

2017 ◽

Vol 5 (1) ◽

pp. 77

Author(s):

Darshan A. Manjunath ◽

Umeshchandra D. Gurugunti ◽

Veerabhadra Radhakrishna

Keyword(s):

Hernia Repair ◽

Hospital Stay ◽

Randomized Control Trial ◽

Operative Time ◽

Preperitoneal Repair ◽

Lichtenstein Repair ◽

Transabdominal Preperitoneal ◽

Operative Complications ◽

The Mean ◽

Randomized Control

Background: There have been a plenty of evolution in surgical techniques of hernia repair. The current standard technique is tension-free repair. The different studies show different results with the use of laparoscopy in performing tension-free hernia repair. Hence a study was conducted to compare the laparoscopic transabdominal preperitoneal repair with open Lichtenstein repair regarding operative complications, pain, analgesic usage, and time to return to normal activities.Methods: A randomized control trial was conducted in the Department of General Surgery in a tertiary center from December 2010 to May 2012. All patients underwent either open Lichtenstein repair or laparoscopic transabdominal preperitoneal repair (TAPP). Both the procedures included a recording of operative time, operative complications, pain, analgesic usage, hospital stay, surgical site infection (SSI), and time to return to normal activities. Mann Whitney U test, student ‘t’ test and Fisher’s exact test were used to study the significance of the difference. A p-value <0.05 was considered significant.Results: The open Lichtenstein procedure was found to have a significantly less operative time compared to TAPP procedure (54±15 minutes vs. 75.7±31.6 minutes; p=0.001; CI=95%; Mann Whitney ‘U’ test). TAPP group had a significantly low pain at 12hrs and 24hrs postoperatively. There was no difference between the TAPP group and Lichtenstein group regarding the mean hospital stay (37.2±12.1 hours vs. 38.2±13.6 hours; p=0.7; CI=95%; Mann Whitney ‘U’ test). The mean time to return to work was 12.1±11.8 days in TAPP group, which was significantly lesser than the Lichtenstein group (20.9±4 days; p= 0.04; CI=95%; student ‘t’ test). No recurrence was found.Conclusions: Laparoscopic TAPP was a safe and effective procedure for inguinal hernia repair, and it can replace open procedure.

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