The medial leaf of the external oblique aponeurosis is sutured to the inguinal ligament.1=Medial leaf; 2= Interrupted sutures taken to suture the medial leaf to the inguinal ligament; 3= Pubic tubercle; 4= Abdominal ring; 5=Spermatic cord; and 6= Lateral
Background: The first author has described a new technique of pure tissue hernia repair and published his results previously1,2. This article describes the results of a comparative study of this new technique and the open mesh repair done in a district level general hospital set up in India. Methods: This is a retrospective study of 269 hernias ope...
Context in source publication
... first two sutures are taken in the anterior rectus sheath where it joins the external oblique aponeurosis. The last suture is taken so as to narrow the abdominal ring sufficiently without constricting the spermatic cord ( Figure 1). Each suture is passed first through the inguinal ligament, then the transversalis fascia, and then the external oblique. ...
Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chro...
... Situma et al.  presented their short-term results of Desarda versus modified Bassini inguinal hernia repair, concluding that there was no difference between these two techniques in regard to pain and return to normal activity. Other results, published by Desarda and his group, were based on a comparison of his technique and the Lichtenstein technique . They reported no recurrence among the 269 Desarda group patients and 1.97% recurrence among the 225 mesh group patients; 6.49% of patients from the mesh group and no patients in the Desarda group reported chronic pain at 1 year after surgery. ...
The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the 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 (D) and mesh-based Lichtenstein (L) techniques. A total of 208 male patients were randomly assigned to the D or L group (105 vs. 103, respectively). The primary outcomes measured were recurrence and chronic pain. Additionally, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12, 24, and 36 months after surgery. During the follow-up, two recurrences were observed in each group (p = 1.000). Chronic pain was experienced by 4.8 and 2.9% of patients from groups D and L, respectively (p = 0.464). Foreign body sensation and return to activity were not different between the groups. There was significantly less seroma production in the D group (p = 0.004). The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 3-year follow-up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.
Ours was a retrospective chart review of all elective open inguinal hernia repairs performed in a single unit at King Edward VIII Hospital, South Africa over an 18-month period. Comparison was made regarding duration of operation, length of hospital stay and complications such as pain, haematoma formation and recurrence between the Lichtenstein and Desarda techniques. The latter was noted to have a shorter operative time and avoided cost and possible complications of mesh usage, which are significant in resource-deprived settings. A larger comparative study with longer follow-up is needed to evaluate the wider suitability of the Desarda repair.
This study compared the short-term outcomes of the non-mesh (Desarda) and mesh (Lichtenstein) methods of hernia repair among Black African patients, with regard to acute postoperative pain, day of return to normal gait, operative time and complications. A total of 101 participants (51 in the Lichtenstein arm and 50 in the Desarda arm) were enrolled into this single centre double-blind randomised controlled trial. The outcome measures were evaluated at 1-2 h, 3, 7 and 14 days. The power of the study was set at 80%, CI at 95% and a two-sided P < 0.05 was considered statistically significant. There was no significant difference in the mean pain score (based on Visual Analogue Scale 0-10) between the study arms [3rd postoperative day (POD): 3.33 ± 1.75 for Lichtenstein and 2.73 ± 1.64 for Desarda, Effect size (CI): 0.59 (-0.088-1.272) and the scores on the 7th POD were 1.31 ± 1.19 for Lichtenstein and 1.31 ± 1.34 for Desarda, effect size (CI): 0.00 (-0.509-0.509)]. No difference was observed in regard to mean day of resumption of normal gait [2.44 ± 1.62 for Lichtenstein and 2.06 ± 1.13 for Desarda, effect size (CI): 0.08 (-0.030-0.193)]. A significant difference was recorded in regard to operative time, with the Desarda repair markedly shorter in duration [15.9 ± 3.52 min for Lichtenstein repair and 10.02 ± 2.93 min for Desarda's repair, effect size (CI): 5.92 (4.62-7.20), P = 0.0001]. Complication rates were similar in the two study arms. The results of the study showed that the effectiveness of the Desarda technique with respect to influencing the early clinical outcomes of hernia repair is similar to that of the Lichtenstein method. However, the operator in this study showed that the Desarda repair requires significantly shorter operative time.
To evaluate the early outcome of Lichtenstein's technique for repair of inguinal hernia using polypropylene mesh. This was a descriptive study conducted over a period of twelve months from 1st July 2007 to 30th June 2008 in Surgical 'B' unit, Lady Reading Hospital, Peshawar. One hundred and twelve patients were received through the out patient department with diagnosis of inguinal hernia. Inclusion criteria was patients above the age of 18 years, reducible hernia, evidence of swelling in groin > 2 months. Exclusion criteria was age less than 18 years, chronic constipation, chronic cough, symptoms of prostatism, irreducible hernia, obstructed hernia, strangulated hernia and patients with diabetes mellitus. All the patients were subjected to inguinal mesh repair using the Lichtenstein technique with polypropylene mesh. Mean age of patients was 48.78 +/- 14.41 years. Sixty patients (53.6%) had right sided inguinal hernia while 46 patients (41.1%) had a left sided hernia and 6 patients (5.4%) had bilateral hernia. Sixty two patients (55.4%) had indirect hernia and 43 (38.4%) cases had direct hernia. Sixteen cases (14.3%) had previous history of surgery for hernia on the same side (recurrent hernia). Mild pain was observed in 53 cases (47.3%), moderate pain in 42 cases (37.5%), and severe pain in 17 cases (15.2%). Four patients (3.6%) in all developed a seroma Two patients (1.8%) developed a haematoma that required drainage. Three patients (2.7%) had a prolonged recovery and presented with abdominal distension. Five cases presented with infected wounds. Lichtenstein's technique of inguinal mesh repair is a safe and effective procedure but emerging trends anticipates the implementation of day case surgery.