Desarda versus Lichenstein repair in treatment of inguinal hernia: our experience in KVG Medical College and Hospital

Background: Desarda technique of inguinal hernia repair introduced in 2001 is still not considered standard tissue-based hernia repair technique. The aim of the study was to compare the tissue based Desarda technique with standard Lichtenstein repair in treatment of primary inguinal hernia.Methods: 72 cases were allocated into 2 groups. Desarda (D Group) had 36 and Lichtenstein (L Group) had 36 patients. Primary outcome factors included operative time measured from skin incision to skin closure. Post operative pain scores was using Sheffield scale. Ecchymosis, hematoma, seroma, surgical site infections, foreign body sensation etc. were evaluated as postoperative complications. A follow up examination was planned for 6 month to look for early recurrence (<6 month) and chronic groin pain.Results: Mean age in desarda’s group 44.94±15.5 years while Lichtenstein group was 45.47±13.12 years. The mean duration of surgery 42.83 min (D) versus 50.72 min (L). Duration of hospital stay 3.38 days (D) versus 4.08 days (L). Time taken to return to normal and work activities was significantly less in Desarda group (p=0.001). After 6-month mean follow up period 1 recurrence is noted in each arm (p=1).Conclusions: On comparison of Desarda with Lichtenstein repair. Desarda technique does not use a mesh. Patients after Desarda's operative procedure gets normal activity sooner as compared to the standard Lichtenstein mesh repair. Complications similar to standardized technique. We also found the use of Desarda technique in patients with indirect hernia is a technically sound option than Lichtenstein technique.

Totally extraperitoneal inguinal hernia repair versus Lichtenstein repair: a one-year follow-up study

The inguinal hernia has an incidence of 27 — 43 % in males. Surgical repair is the most accepted treatment to prevent the development of complications. Laparoscopic inguinal hernia repair has become popular worldwide and includes the use of a laparoscopic technique for mesh placement behind the defect. Objective — to assess whether totally extraperitoneal (TEP) inguinal hernia repair shows benefits over Lichtenstein repair in intraoperative and one‑year follow‑up postoperative outcomes for male patients with primary unilateral inguinal hernia. Materials and methods. 53 males were randomly allocated to two groups. Group 1 included 27 patients who underwent totally extraperitoneal hernia repair using self‑gripping lightweight mesh, and group 2 included 26 patients who were treated surgically with Lichtenstein repair using lightweight mesh. Results. Both groups were comparable in mean age, type of hernia, body mass index and patient’s distribution according to the European hernia society classification. TEP repair takes on average a little less time as compared to Lichtenstein repair, and this difference is not statistically significant. The mean of visual analogue scale for pain scoring in the first 24 hours after surgery as well as in the next 24 hours is statistically significantly smaller in group 1 compared to group 2. The mean time taken to return to work was 2.15 times longer in group 2 than in group 1, and the difference was statistically significant. Conclusions. Totally extraperitoneal hernia repair shows potential benefits over Lichtenstein repair for primary unilateral inguinal hernias as it causes less pain in the postoperative period and ensures early return to work.

Desarda’s Repair Vs Lichtenstein Repair in Indirect Inguinal Hernia -Preferred technique

Aim: To compare the outcome of Desarda`s technique with that of Lichtenstein mesh hernioplasty in terms of chronic pain, recurrence and infection. Methods: A prospective comparative study with randomized controlled trial was conducted at Lahore General Hospital in Surgical Department to appraise the outcome of Desarda Hernioplasty in comparison with Lichtenstein Hernioplasty technique to evaluate recurrence, wound infection and chronic groin pain. The Desarda repair is used to treat inguinal hernia without the use of mesh. Results: Total sixty (n=60) patients were included in the study by dividing into two groups Group A and B with mean age 40.5 and 39.5 years for Desarda vs Lichtenstein groups correspondingly. Insignificant statistical difference was noted in both groups regarding wound infection but considerable statistical advantage was noted regarding recurrence and Chronic groin pain for Group A patients in comparison to Group B. Conclusion: We concluded that Desarda repair is emerging technique and cost effective with lesser pain, infection and recurrence than other techniques. Keywords: Desarda`s repair, Lichtenstein repair, wound infection, chronic groin pain and recurrence

Desarda repair no Mesh and Lichtenstein repair for inguinal hernia (A study of 2793 patients)

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p<0.05).The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair.

Comparative Study between Lichtenstein Repair and Trans Abdominal Pre Peritoneal Repair of Inguinal Hernia (TAPP)

Background Inguinal hernia repair is one of the most widely performed surgical procedure. Among the techniques used, the open Lichtenstein repair is still the most widely performed. However, in the last decade there has been an increased interest in the laparoscopic approach for inguinal hernia repair, mainly represented as the trans-abdominal pre- peritoneal (TAPP) technique. As described in recent studies, TAPP approach entails the benefits of minimally invasive surgery, such as less pain and early recovery. Objective s: This study aims to compare between lichtenstein repair of inguinal hernia and trans-abdominal pre-peritoneal repair of inguinal hernia (TAPP) as regard their hospital stay, cost, intra-operative & post-operative complications and short term recurrence. Patients and Methods Our study was carried out on (50) male patients with inguinal hernia, 25 patients underwent laparoscopic TAPP repair and 25 patients underwent open Lichtenstein repair. We found a highly significant difference of laparoscopic TAPP Repair in decreasing post-operative pain than in open repair. Results Comparative study between the 2 groups revealed non-significant difference as regards age and sex of the patients. Comparative study between the 2 groups revealed non-significant difference as regards all socio-demographic data. Comparative study between the 2 groups revealed non-significant difference as regards type and side of hernia. Comparative study between the 2 groups revealed; highly significant increase in operative duration in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in post-operative pain score and post-operative hospital stay; in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Comparative study between the 2 groups revealed; highly significant decrease in intra-operative complications in laparoscopic group; compared to open group of patients; with highly significant statistical difference. Conclusion Our study showed that laparoscopic TAPP approach for inguinal hernia repair reduces early post-operative pain. Furthermore, it is related to less complications, although it takes a longer operative time and higher cost.

Desarda Repair No Mesh and Lichtenstein Repair for Inguinal Hernia a Study of 2793 Patients

Introduction: The objective of this study is to compare the outcomes of Desarda repair no mesh and Lichtenstein repair for inguinal hernia. Methods: This is a prospective randomized controlled trial study of 2793 patients having 2936 hernias operated from January 2002 to December 2020.1434 patients were operated using Lichtenstein repair and 1359 using Desarda repair. The variables like age, sex, location, type of hernia, tolerance to local anesthesia, duration of surgery, pain on the first, third and fifth day, hospital stay, complications, re-explorations, morbidity and time to return to normal activities were analyzed. Follow up period was from 1-10 years (median 6.5 years). Results: There were no significant differences regarding age, sex, location, type of hernia, and pain in both the groups. The operation time was 53 minutes in Desarda group and 43 minutes in the Lichtenstein group that is significant (p<0.05). The recurrence was 0.4 % in Desarda group and 0.4 % in Lichtenstein group. But, there were 14 cases of infection to the polypropylene mesh in the Lichtenstein group, 7 of this required re-exploration. The morbidity was also significantly more in Lichtenstein group (5,1 %) as compared to Desarda group (3.1 %). The mean time to return to work in the Desarda group was 8.26 days while a mean of 12.58 days was in the Lichtenstein group. The mean hospital stay was 29 hrs. In Desarda group while it was 49 hours in the Lichtenstein group in those patients who were hospitalized. Conclusions: Desarda repair scores significantly over the Lichtenstein repair in all respects including re-explorations and morbidity. Desarda repair is a better choice as compared with Lichtenstein repair

Outcome of Laparoscopic Total Extra Peritoneal Versus Lichtenstein Repair For Treatment of Inguinal Hernia: A Randomized Control Trial

OBJECTIVES: To compare the outcome of laparoscopic total extra peritoneal (TEP) repair versus Lichtenstein repair (LR) of inguinal hernia in terms of post-operative pain, hematoma, seroma, wound infection and early recurrence. METHODOLOGY: This randomized control trial was conducted at Surgical Unit III, General Hospital Lahore, Pakistan during the period June 2017 to May 2018. Male patients aged up to 50 years diagnosed with unilateral, reducible primary inguinal hernia were randomized into two groups, Group A (TEP) and Group B (LR), with 38 patients each. Data was collected prospectively on structured proforma. Patients were regularly followed up for one year for early postoperative complications. Statistical analysis was done using SPSS version 26. RESULTS: Out of 76 patients, mean age for TEP was 36.72±4.50 years and LR was 34.42±6.8 years. No significant difference was found in both the groups in terms of short-term postoperative complications. LR group had comparatively high rate of postoperative complications; hematoma formation (n=3/38; 7.9%), wound infection (n=3/38; 7.9%) and seroma formation (n=1/38; 2.6%). Postoperative pain with Visual Analogue Score in TEP group on the 1st day, 3rd day, 7th day and 1 month follow up was less as compared to LR group. CONCLUSION: The present study concludes that TEP is better than LR in inguinal hernia in terms of less postoperative pain after 1 month. However, no statistical difference was found in seroma and hematoma formation and wound infection.