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Desarda repair
Hi @drtowfigh,
I’ve recently watched your excellent Hernia Talks on YouTube with Dr Andreas Koch (recorded approx. 1 year ago) and Dr Yunis (recorded approx. 2 years ago)
Dr Yunis explained that he generally uses Shouldice repairs for direct hernias and Desarda repairs for indirect hernias (he may have said for small hernias in each case). Over 4 years, at the time of recording, he said his numbers (recurrence/pain) for Desarda repairs were excellent. He also mentioned that there’s minimal risk to patients with the Desarda repair, which sounds appealing to someone watchful waiting like myself.
Dr Koch (at around the 46th minute in your conversation) said that you need a very good external aponeurosis to perform a Desarda repair and in Europe, there’s a greater tendency for people to be overweight and in his experience, which he said he believes to be similar in the US, he sometimes sees a very weak external aponeurosis and it doesn’t make sense to do a Desarda in those circumstances. Dr Koch explained that his preferred repair method is a modified Shouldice.
I’d really appreciate your current thoughts about the Desarda repair please:
– Do you feel it’s now a good option for people to consider?
– Does it offer minimal risk to patients generally and vs other tissue repairs?
– If a Desarda repair fails and a hernia recurs, can it then be repaired with a Shouldice repair?
– In your experience, is it more common for people in Europe and the US to have a weak external aponeurosis?
– Is there a likelihood with the Desarda repair that the strip of the external oblique aponeurosis which is separated and then sutured to form a new posterior wall of the inguinal canal (if I’m describing this accurately), could wither and weaken in time due to it being cut, increasing the risk of recurrence, or does it remain live and healthy?
– An earlier post on the forum cited that Desarda repairs can lead to incisional hernias due to weakening the area around the operation site. Is this something that you’re aware of and concur with?
Many thanks,
Jack
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3 Replies
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Those are good questions by Jack.
Considering the weakness of the tissues, I have a related question about the transversalis fascia double breasting in the shouldice. Is it possible that since the tissue are no longer being stretched, that they might actually strengthen? Possibly even fuse given that they are of the same cell structure?
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WB,
That’s the reason the words “tailored approach” always make me uneasy. You just don’t know what you’re going to come out with: Shouldice, Desarda, mesh, or some combination or variation. The criteria are very unclear, subjective, vary from surgeon to surgeon, and even contradictory between surgeons.
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Jack, I’m not medically trained but whilst waiting on more qualified answers from those who are I thought I’d just say I’ve seen videos, photos of desarda patients and many are both western and much older than I think you are.
You can also read testimonials on Prof Desarda’s site, some are from 60yrs plus western patients.
Finally a poster on here, Baris, had am unfortunate experience with Dr Koch and cane round expecting tisuue repair to find mesh. As far as I can make out it was because Dr Koch felt the tissue was not strong enough but Shouldice clinic, who saw and operated on Baris, subsequently stated it was good and strong enough for tissue repair and if they’d have done it, they wouldn’t have used mesh.
This isn’t to denigrate Dr Koch as I have seen glowing testimonials about him but it does show the tissue issue is subjective.
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