Learning about various techniques: Dasarda Technique versus Mesh surgery?

Tissue (non-mesh) repair is usually an option for inguinal hernias. There are multiple options for tissue, the most common and highly validated being the Shouldice repair and the Bassini repair.

Technique and the expertise of your surgeon in performing a tissue repair is of utmost importance, as these are most likely to affect outcome.

That said, in general, long term outcomes are best with mesh repair, when looking at hernia recurrence rates. They are typically (much) lower with the mesh repair. Anyone who claims a less than 1% hernia recurrence rate with non-mesh repair should be queried as to their data, whether it is published in a peer reviewed manner, length of followup, how recurrence was determined, etc. It is very difficult to get recurrence rates that low with tissue repair, as it relies on the integrity of the Patient’s tissues, and anyone who has a hernia, by definition, has some tissue impairment. For example, studies show lower amount of mature collagen in Patient’s with hernias. This, sewing abnormal tissue to itself is more likely to fail than if new tissue/mesh is brought in to support the repair.

Chronic pain may be more in some patients with mesh implantation. And that is certainly a trend we are seeing in this age of mesh use as the gold standard for hernia repair of the groin. However, non-mesh hernia repair is also at risk for chronic pain. In fact, there are studies which show no difference in incidence of chronic pain between the mesh and non-mesh eras.

With regard to the Desarda technique, I am certainly familiar with it. My concern is that it is similar to a technique performed in the 1950s/60s which was eventually abandoned due to its high recurrence rates. I remain skeptical about it until there is more validation of this technique.