Desarda’s versus Lichtenstein technique of inguinal hernia repair

Abstract

INTRODUCTIONInguinal hernia is one of the most common diseases manage by surgeon.1 A hernia is abnormal protrusion of a viscus or a part of viscus through an opening in the wall of cavity containing it. It tends to occur at natural areas of weakness, where muscles are not strong and are vulnerable to intra-abdominal pressure. The estimated lifetime risk for inguinal hernia is 27% for men and 3% for women. 2The choice of a surgery depends on the surgeon as there were no written surgical guidelines for hernia treatment till 2009. [3][4][5] There is a considerable variation in the efficiency of all these procedures which is calculated by the rate of recurrence, complications which is also influenced not only by the different techniques but also by experience and the technical skills of the surgeons. 6 However, the ideal method for modern hernia surgery should be simple, cost effective, safe, tension free and permanent. The Lichtenstein operation to a great extent ABSTRACT 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, postoperative 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, postoperative 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.

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 .…”

“…EHS guideline concludes that operation technique using mesh results in lower recurrence than technique which do not use mesh but we found no recurrence in our study in either group at 2 years follow up. Many studies show similar results 10,14,15 . However, Desarda, in a clinical trial in small district in India comparing his technique to Lichtenstein repair reported no recurrence in his technique versus 4 recurrences in mesh group 26 .…”

“…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 .…”

“…There are some other studies haveing similar observation 10,11,12 indicating that Desarda repair as acclaimed by its inventor indeed a tension free tissue repair. Many studies have shown no difference in immediate post-operative pain 13,14 . As the day passes difference in pain intensity between two arms was reduced indicating that immediate postoperative pain is comparable in two groups.…”

“…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 .…”