by Vishnuprasad on  June 9, 2015 at 6:37 PM Health In Focus
Less Complex Inguinal Hernia Surgery Without Mesh Getting Popular
Hernias are abnormal bulges developed by a weakness or hole in the abdominal wall tissue called fascia.

Inguinal hernia is one of the most common types of hernia and they represent approximately two-thirds of adult hernias. It can affect anyone from their childhood to old age but it is much more common in men than in women.

Around 2 million inguinal hernia cases are reported every year in India. Numerous repair methods have been introduced for inguinal hernia in the country, but mesh repairs such as laparoscopic procedures are also used widely.

In the laparoscopic procedure, anesthesia is usually given, and a small incision is made in or just below the navel. The abdomen is inflated with air as the surgeon can see the abdominal organs. A thin, lighted tube called a laparoscope is inserted through the incision. Other small incisions in the lower abdomen are used to insert the instruments to repair the hernia. Mesh - a simple piece of sterilized cloth - is then placed over the defect to reinforce the belly wall.

Maharashtra-based senior surgeon and hernia expert Dr. Mohan P. Desarda is a strong advocate for mesh-free hernia repairs. He claims that mesh repairs have many complications like pain, recurrence, infection, rejection, migration and testicular damage.

The head of the Pune-based Dr. Desarda's Hernia Center was recently invited to the 1st World Conference on Abdominal Wall Hernia Surgery held in Italy from 25 to 29 of April 2015.

The international conference had witnessed the participation of the European Hernia Society, the American Hernia Society,the Annual Congresses of the Asia-Pacific Hernia Society, the Australasian Hernia Society and the Afro Middle East Hernia Society.

Dr. Desarda presented his mesh-free hernia repair known as 'Dr. Desarda Repair' at the international conference, which he has been practicing for more than a decade. He has successfully carried out this method on more than 2,500 patients till today.

"In traditional operations, surgeons stitch a mesh by open or laproscopic surgery. In my method, a strip of a strong nearby muscles is stitched on the weak spot or the hernia hole instead of mesh. Therefore, protection starts on the operation table itself. This operation does not require general anesthesia, it is done under local or spinal anesthesia," Dr. Desarda explained.

Dr. Desarda said that the operation is very simple to do and easy to understand for any surgeon.

"This is a pure tissue repair that resembles the Lichtenstein repair - mesh based open repair known as tension-free repair - in its simplicity. Results are superior or equal to Shouldice repair that reports relatively lesser chronic pain as compared with mesh-based open repair. The repair is remarkable in its simplicity," he said.

Dr. Desarda clarified that time required for the mesh-free surgery is average 30 minutes and the patient can be on his foot as soon as anesthesia effect is gone.

"The patient is admitted in the morning and taken for surgery immediately after preparation. The patient can bend, squat, climb up the staircase, carry luggage and travel or go to office within couple of days after surgery without any fear of recurrence. Normally, the patient can pass urine on his own within 4-5 hours and he can be mobile in the wards same day, night or next day morning, and also be ready to get discharged and go home," he said.

There are no restrictions on his movements or food in-take after the surgery. The most notable quality of this repair is that there is virtually no recurrence or pain. "Patients from foreign countries come to my institute and get back to their country on the third day carrying their heavy luggage and a journey of 20-22 hours without any physical problem. There are more than 60 centers all over the world where this technique is being routinely used by many surgeons," he said.

Dr. Desarda claimed that mesh, the foreign body used in traditional repairs, has many inherent disadvantages.

"A mesh is nothing but a simple cloth prepared from synthetic threads of polypropylene. It is a delicate cloth and therefore unable to give immediate protection following the surgery. It takes 2-3 years for a mesh inserted in our body to give real protection against reappearance of hernia. Also, if the patient gets an attack of cough or sneezing during this period then the mesh is torn resulting in reappearance of hernia," he said.

He said that people in India are at higher risk for inguinal hernia reappearance because of the low and high quality mesh being manufactured and sold in the country.

"High quality mesh is intended for rich people and poor people get low quality mesh for their surgery. This discrimination puts people at higher risk for inguinal hernia reappearance. Most importantly, mesh is a simple cloth. It was given a special name (Mesh) to sell in the market at an exorbitant price. It is estimated that companies are selling those meshes worth Rs. 1,000 crore every year in India alone," he said.

'Dr. Desarda Repair' is included in the latest edition of the 'Baily & Love' textbook of surgery of international repute and soon a full chapter shall be published in the Atlas of General Surgery.

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