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

Abstract

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.

Desarda Versus Lichtenstein Repair for Primary Inguinal Hernia in Men: Results of A Randomized Control Trial

“…The rate of wound infection in mesh vs non-mesh technique of inguinal hernia surgery is found 3.4% vs 2.8% in a systematic review of 16 trials 21 . Our results (4.35 vs 1.85%, L and D respectively) are consistent with most of the RCTs published so far [12][13][14][15]20 .…”

“…Nearly similar numbers of patients have returned to their basic activity at day 1-2 after surgery. There are some studies with similar results 14,15 . But when followed up to observe the required time to resume their work activity D group showed statistical superiority (14.19 vs16 No significant difference observed in most of the randomized trial in mesh vs non-mesh repair as in our study 12,16,19 .…”

“…We calculated operating time as time taken only for repair as because time usually varies in dissection of sac of different types which should not be included to compare the repair procedure. Many RCTs of different parts of the world published similar results 11,13,15,17,19,24 .…”

“…We have found no significant difference in CPIP in our study though early post-operative pain was lower in D group. There are many RCTs those have shown similar results in CPIP 11,12,15,20 but one study concluded that CPIP was more frequent in L group where they considered persistent pain more than one month instead of 3 or 6 months 14 . Chronic groin pain after hernia repair with mesh was reported to range from 28.7% to 43.3% 23 .…”

All in One Technique Versus Lichtenstein Technique for Treatment of Inguinal Hernia in Zagazig University Hospitals.

“…As regarded age, For Lichtenstein group the Age of the patient in other study was ranged from 18-70 years with a mean age of 50 years for Lichtenstein technique [6]. The age of patient ranged from 22-81 years and the mean age was 49 years for Lichtenstein hernioplasty [7].…”