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Desarda Hernia Repair – Suture Material
I’ve found a very good surgeon that is happy to perform a Desarda repair on what he suspects is an indirect right inguinal hernia I have. The surgeon would prefer to use prolene sutures for the repair but is willing to use absorbable sutures which is the decision I’d like some help with. My ideal repair will leave nothing behind in the long term but I of course don’t want a recurrence. In the literature I have reviewed based on data from the Swedish Hernia Register it appears that there is a negligible difference between absorbable and non-absorbable sutures for mesh fixation. While this shares similarities it is not the exact same as a Desarda repair. To make the most informed decision I possibly can I want to ask on here if anyone knows of peer reviewed studies into this by people other than Desarda. I believe I read that Dr Brown who is mentioned on here quite frequently uses silk sutures which are considered non-absorbable but are absorbed long term however I’m not aware of what recurrence rates he achieves with these.
If anyone is willing to contribute any useful information on this topic it would be greatly appreciated. -
5 Replies
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We do know that the recurrence rate is higher after tissue repair if using absorbable suture vs non-absorbable suture. All tissue repairs were originally described with non-absorbable suture. If you wish to have a tissue-based hernia repair with absorbable suture, then the higher recurrence risk is the reality of it. And note that once you start recurring from tissue-based repairs, mesh-based repairs become the next reality.
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I don’t think that you can use any mesh fixation data for your research. The inflammatory response from mesh is so great that many surgeons don’t use any fixation at all. No suture, Prolene suture, absorbable suture, titanium tacks, etc., they’re all the same.
Generally, I don’t see how a layperson can choose a suture material for a hernia repair procedure. The only valid way to make a proper choice for long term results is through long term data. The best that you can get from the internet are references to professional publications, or opinions from people who have a history of successful repairs. If Dr. Brown recommends silk sutures why would you need to look any farther?
Maybe you can get Dr. Brown and your surgeon together for a phone conversation? Some surgeons are open to listening and learning, some are not. Worth asking. Good luck.
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Thank you very much for your reply Dr Towfigh. My surgeon has made me aware that should a tissue repair fail that mesh is the next step. I wish to understand the risks involved in this so I can make the best most well informed decision for myself. You mentioned that you know the recurrence rate is higher for tissue repairs using absorbable sutures. May I ask if you recall a study I can look at regarding this as It would be invaluable so that I may quantify the risk. I’ve found very few papers on this topic and sample groups have been very small so it’s been difficult to reach a conclusion.
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Thank you for replying. I wouldn’t say I’m choosing the suture material but I do have choice. Desarda used to use prolene sutures which my surgeon prefers using as they have achieved good results with this and haven’t used absorbable sutures. Desarda now uses Polydioxanone absorbable sutures which my surgeon is willing to use but hasn’t used them before and there isn’t a great deal of data on long term outcomes from using these to his knowledge other than from Desarda himself. Right now my choice is certainly between them but if a surgeon such as Dr Brown has had good success with silk I’d ask my surgeon if he’d be happier and more confident to use that over Polydioxanone.
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