A PROSPECTIVE COMPARATIVE STUDY OF DESARDA’S TECHNIQUE

WITH LICHTENSTEIN MESH REPAIR IN TREATMENT OF INGUINAL

HERNIA IN A TERTIARY CARE CENTRE IN TAMIL NADU, SOUTH INDIA -
A SINGLE INSTITUTION STUDY

Dr. RAMKI ARUNACHALAM GANESH

2nd YEAR POSTGRADUATE
DEPARTMENT OF GENERAL SURGERY,
SREE BALAJI MEDICAL COLLEGE, CHENNAI
GUIDED BY:
Prof. Dr. B.V. SREEDEVI,
Dr. S. BALAJI
INTRODUCTION
A hernia is defined as protrusion of whole or a part of a viscus
through the wall that contains it.
Hernia repairs are the most routinely performed surgery around the
globe, amongst which Inguinal hernia is the most commonly
performed one.
About 27% of males and 3% of females are at risk of developing an
inguinal hernia over their lifetime.
Surgery is considered to be the best treatment modality for Inguinal
hernia.
INTRODUCTION (contd)
Inguinal hernias arise from the posterior wall of the inguinal canal
which is an area of natural weakness covered by fascia transversalis,
whose failure results in hernia formation.
This region is susceptible to weakness because of structures like the
spermatic cord and round ligament that pass through it.
Factors such as smoking, collagen defects, raised intrabdominal pressure
due to coughing, constipation, heavy lifting etc. are also associated with
development of inguinal hernia.
The outcomes for the patients have significantly improved, owing to the
improvements in surgical techniques.
INTRODUCTION (contd)
The various surgical techniques of inguinal hernia repair are:
i) Open techniques:
Tissue repairs: Prosthetic repairs:
1.Shouldice repair 1. Lichtenstein’s tension free
2. Mcvay repair repair
3. Bassini’s repair 2. Plug and patch technique
3. Prolene hernia system
4. Stoppa’s technique
INTRODUCTION (contd)
ii) Laparoscopic approach

1. Transabdominal Preperitoneal repair (TAPP)

2. Totally extraperitoneal repair (TEP)
3. Intraperitoneal onlay mesh repair (IPOM)
INTRODUCTION (contd)
Early in the 1980s, Lichtenstein described his mesh-based,
tension-free technique for reconstructing the inguinal floor.
Owing to its consistently reproducible low rates of recurrence,
this method has now been deemed the gold standard.
However, this method has its own set of disadvantages like
postoperative pain, nerve injury, infection, testicular atrophy,
foreign body sensation and seroma formation etc.
INTRODUCTION (contd)
Despite the various modalities available for treatment of
this common condition, no surgeon has ideal results.
This demands the development of a new hernia repair
method with lower rates of complications.
Dr. M.P. Desarda, developed a new technique, which
utilizes an undetached strip of the external oblique
aponeurosis sutured to the inguinal ligament below and
conjoint tendon above to strengthen the posterior wall.
INTRODUCTION (contd)
This technique was published through his study in the
international journals in 2006 and is now known as
Desarda’s technique.
AIM & OBJECTIVES
To compare the effectiveness between Desarda’s
technique with Lichtenstein mesh repair in treatment of
inguinal hernia.
To compare the complications associated with both the
modalities of treatment.
To decide on the better treatment for inguinal hernia based
on the findings of the study.
MATERIALS AND METHODS
STUDY AREA: This study was conducted in Sree Balaji
Medical College and Hospital, Chennai.
STUDY POPULATION: Patients presenting with Inguinal
hernia, in the department of general surgery at SBMCH
STUDY DESIGN: Prospective study
STUDY DURATION: 1 Year (May 2022 to Apr 2023)
MATERIALS AND METHODS
SAMPLE SIZE: This study includes 70 patients
INCLUSION CRITERIA:
All patients who present in surgical outpatient department
with inguinal hernia :
• Direct
• Indirect
• Pantaloon
MATERIALS AND METHODS
EXCLUSION CRITERIA:
• Recurrent Inguinal hernia
• Inguinal Hernia with complications
(Obstruction/Strangulation)
• Children
• Pregnant women
METHODOLOGY
A total of 70 cases diagnosed to have inguinal hernia were
included in the study fulfilling the inclusion and exclusion
criteria. Patients were randomly divided into two equal
groups.
• Group I (control group) (35 patients)
Subjected to Lichtenstein’s tension free mesh repair
• Group II (Study Group) (35 patients)
Subjected to Desarda’s technique of non mesh tissue repair
METHODS OF DATA COLLECTION
Data for the proposed study was collected in a pretested
proforma which included various parameters like type of
hernia, duration of symptoms.
Detailed history and physical examination were done.
After surgical intervention, patients were followed up
and noted for complications like groin pain, surgical site
infections and duration to return to normal non
strenuous activity.
FOLLOW-UP
Patients were followed up till discharge, following which
they were followed up after 2 weeks, 1 month, 2 months,
6 months
SURGICAL TECHNIQUE
 Skin incision made about 2 cms above and parallel to the
inguinal ligament.
 Incision deepened in layers.
 EOA identified and divided, exposing the inguinal canal and
its contents.
 Cord structures hooked out and contents separated from
hernial sac (Indirect).
 Indirect hernial sac opened. Contents reduced. Sac transfixed
and ligated at the level of preperitoneal pad of fat.
SURGICAL TECHNIQUE
Desarda’s Technique Lichtenstein
 The medial leaf of the EOA is sutured to the  A 6x11 cm piece of prolene mesh was
inguinal ligament from the pubic tubercle to fixed with conjoined tendon above and
the deep ring with 2-0 Prolene. inguinal ligament below using 2-0
 EOA was again incised about 1.5-2.0 cm prolene
above the suture line thus creating a strip that
 EOA and rest of the wound closed in
was attached medially and laterally with
original aponeurosis. regular manner.
 The upper margin of this strip was sutured
with conjoined muscle/tendon using running
2-0 Prolene.
 Spermatic cord kept in place. The Neo – EOA
end is sutured with lateral EOA end.
 Rest of the wound closed in regular manner.
SURGICAL TECHNIQUE
Desarda’s Technique Lichtenstein

Image 1 Image 2

Image 1

Image 3
RESULTS
AGE DISTRIBUTION OF PATIENTS
DESARDA’S LICHTENSTEIN’S
Total Number 35 35
Minimum Age 21 20
Maximum Age 62 78
Mean Age 40.45 49.64
SD 13.70 17.85
RESULTS
POST OPERATIVE PAIN ASSESSMENT BASED ON
VISUAL ANALOGUE SCORE ( MILD TO MODERATE)
DESARDA’S LICHTENSTEIN’S
Total Number 35 35
1st POD 29 31
3rd POD 17 24
5th POD 11 19
RESULTS
POST OPERATIVE COMPLICATIONS
DESARDA’S LICHTENSTEIN’S
SEROMA 1 2
SSI 1 3
HEMATOMA 1 1
ORCHITIS 0 0
RECURRENCE 0 0
RESULTS
DURATION OF HOSPITAL STAY
DESARDA’S LICHTENSTEIN’S
Total Number 35 35
Less than 3 days 31(5.71%) 28(2.85%)
More than 3 days 4 (94.29%) 7 (97.14%)
P Value 0.19
RESULTS
RETURN TO NON STRENUOUS ACTIVITIES

DESARDA’S LICHTENSTEIN’S
1 – 7 days 10 6
8 – 15 days 22 19
16 – 30 days 31 28
P value <0.003
DISCUSSION
Inguinal hernias are the most common hernias
encountered by a surgeon .
A physiologically weak posterior inguinal canal wall is
the main cause of inguinal hernia in most of the patients
Theoretically an ideal hernia repair should be tension free,
tissue based with no potential damage to vital structures,
no long-term complications like pain and recurrence.
DISCUSSION
Although Lichtenstein tension free mesh repair has gained
popularity and is considered the gold standard among the surgical
repair of hernias, it has certain limitations like availability of
mesh, cost and complications associated with it.
Other tissue based repairs are almost obsolete owing to its tension
in the repaired tissue.
Desarda’s technique like Lichtenstein, is tension free and also
provides a sound physiological and dynamic posterior wall of the
inguinal canal.
DISCUSSION
There was no significant difference in regarding with age,
sex, duration of hernia in both the groups.
Numerous studies demonstrate that Desarda's technique
results in shorter surgical duration as well as fewer
postoperative complications like groin pain, abdominal
wall stiffness, shorter hospital stays, and quicker return to
normal activity, which was found to be similar in this
study.
DISCUSSION
Surgical site infections: 1 case (2.8%) in the Desarda’s
group when compared to Lichtenstein’s repair where there
were 3 (8.5%) cases.
The duration of return to normal non strenuous activity
was significantly less in Desarda’s group in comparison
with Lichtenstein’s group.
Over a period of 6 month follow-up there were no
recurrences in both the groups.
CONCLUSION
When compared to other tissue repair techniques, Desarda's repair is
a physiologically sound, simple, and easy-to-learn technique that
uses no mesh.
It can be performed under local anesthesia when patient is unfit for
regional/general anesthesia and is associated with a lesser duration
of surgery and no mesh associated postoperative complications, with
a rapid recovery time in comparison with Lichtenstein’s mesh repair.
It can be used in contaminated surgical fields where mesh could not
be used, and in patients with financial constraints.
CONCLUSION
To conclude, Desarda’s no mesh repair, when compared to
Lichtenstein’s mesh repair produces same or better results.
Although owing to the small sample size, large scale study
and long term follow up may be needed to identify
recurrences and usage of this technique in patients with
thinned out external oblique aponeurosis.
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