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DESARDA technique
Please express your opinions ..i was watching this video and compared to all others methods ..seems to me the Best And less invasive? https://www.youtube.com/watch?v=2VlXH1MOqvE&lc=z22zy3w5jtu5ht5uvacdp434qx1dwjpvv5dmisaeidxw03c010c.1532941372405302&feature=em-comments
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20 Replies
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quote dog:I didn’t hear about modified Shouldice technique with absorbable wire?Oops! I blame that on my bad copy and paste. I meant absorbable sutures. They are technically made of polymers.
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quote John Fortem:All valid arguments. But in Shouldice, they use a steel wire for suturing. Unless it’s a modified Shouldice technique with absorbable wire.I didn’t hear about modified Shouldice technique with absorbable wire?
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quote dog:Here is very respectfully doctor’s onion below !
The Desarda technique is very simple and seemingly sensible as a way to repair an inguinal hernia. However, as a responsible academically driven hernia specialist, I am responsible to data driven decisions. The Shouldice repair is also an elegant repair with a history of 70 years of success. It has been studied extensively and clearly remains the gold standard for a non mesh inguinal hernia repair. While it is more complex than the Desarda technique, the results from Shouldice are consistent with a long history of safety and patient satisfaction and long term recurrence rates of 2-4 %.
While initial results may be excellent from the Desarda repair, long term data does not exist.
For this reason, the Shouldice repair remains the gold standard for non mesh hernia repair.Jonathan Yunis MD FACS
http://www.centerforherniarepair.com
941-953-5917All valid arguments. But in Shouldice, they use a steel wire for suturing. Unless it’s a modified Shouldice technique with absorbable wire.
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Here is very respectfully doctor’s onion below !
The Desarda technique is very simple and seemingly sensible as a way to repair an inguinal hernia. However, as a responsible academically driven hernia specialist, I am responsible to data driven decisions. The Shouldice repair is also an elegant repair with a history of 70 years of success. It has been studied extensively and clearly remains the gold standard for a non mesh inguinal hernia repair. While it is more complex than the Desarda technique, the results from Shouldice are consistent with a long history of safety and patient satisfaction and long term recurrence rates of 2-4 %.
While initial results may be excellent from the Desarda repair, long term data does not exist.
For this reason, the Shouldice repair remains the gold standard for non mesh hernia repair.Jonathan Yunis MD FACS
http://www.centerforherniarepair.com
941-953-5917 -
Here is respond of very respectful doctor ..not having his permission to give his name …We all probably would love to know what Dr. drtowfigh would comment here !
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The Desarda technique is very simple and seemingly sensible as a way to repair an inguinal hernia. However, as a responsible academically driven hernia specialist, I am responsible to data driven decisions. The Shouldice repair is also an elegant repair with a history of 70 years of success. It has been studied extensively and clearly remains the gold standard for a non mesh inguinal hernia repair. While it is more complex than the Desarda technique, the results from Shouldice are consistent with a long history of safety and patient satisfaction and long term recurrence rates of 2-4 %.
While initial results may be excellent from the Desarda repair, long term data does not exist.
For this reason, the Shouldice repair remains the gold standard for non mesh hernia repair. -
[h=1]A comparative study of Desarda’s technique with Lichtenstein mesh repair in treatment of inguinal hernia: A prospective cohort study.[/h]
https://www.ncbi.nlm.nih.gov/pubmed/28131917 -
I think most people are able to travel post op but if you are far away if possible you may want to consider staying in a hotel for a couple of days and stop in and see dr. Brown a couple days post op make sure all looks good and then travel back. This way you can recover a little bit, be close by should you need to see him for any reasons relating to the surgery and then get the clearance to travel back. Most surgeons want to see to back in a week or two anyways so this way staying local for a few days will mean yoibdknt have to travel back later.
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Hi Dear Jnomesh That is what i think ! The only one think to my Big surprise claim to do laparoscopic repairs with no mesh ? It was his assistant told me. I will call on Monday to ask one more time… How it possibly ? I agree that more durable would be open. My problem getting worse..need to stop by job periodically to sit down to get some relive.. So needs to act.
How will i fly back after surgery this concerning me… ? -
If it were me and it was between dr. Brown and Chen I would definitely go with dr. Brown. This is his speciality open non mesh repairs. I would bet Chen does way more mesh repairs then ooen repairs and does way more laparoscopic repairs with mesh. The non mesh laparoscopic repair still seems to be in its infancy so I woundnt want to be a statistic.
Currently all the best tissue repairs-desarda shouldice bassini etc are all done openly.
please keep us posted on how your surgery goes! -
Thank you to everyone who responded ! I was on Dr. Brown web but didn’t see that page….i wish he also would be proficient in laparoscopic, that way he would pick best option … I spoke with him and like him a lot . Will take me fly 1 hour and surgery be done very fast no waiting list.
I am just wondering will i miss something not visiting Dr. Chen http://surgery.ucla.edu/hernia/our-expert-team {Drive 1 hour but long waiting } he performs no mesh laparoscopic { possibly the only one doctor } but what methods he use ..not known ?
Regarding safety.. Dr Brown believes that open much safer because you see nerves much better….but others disagree . I think with out mesh open one would be more durable ..What is your opinion ? It is too sad that we must be almost doctor our self in order pick the best option.
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Jnomesh Thank you! I was on Dr. Brown web..but didn’t see that page. I think that would be the best option..i just wish he also would be perfect with laparoscopic surgery …that way his point of view would be even greater and i know i don t miss anything .. I can fly to him [ONE HOUR to FLY ..but how can i fly myself after that surgery ..any experience like that ? } but he can do quick .!!! and he is very nice person ..but i didn’t see too much online posts about his work
I think the only question ..Would i have will i miss something ..not seeing Dr. Chen,MD ? ..receptionist told me he does no mesh laparoscopic … Do you think he could do those methods just with laparoscopic ? https://www.sportshernia.com/no-mesh…repair/repair/ …..it takes a lot of time before i can see him !!! BUT it is ONE HOUR to DRIVE …
Also about safety concern…Dr Brown told me open surgery less risky because you see all nerves better.. however Dr. drtowfigh kindly told me it is wrong assumption .all about experience .Chaunce1234 John Fortem Jnomesh Good intentions and all Great members What do you think ?
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I posted a longer reply but it has been held for review, probably because it included many links.
Anyway, here’s another limited study on Desarda vs Lichtenstein (the original simple open flat-mesh repair) from Europe (Poland), it appears that recurrence was the same risk in both categories, and chronic pain was also low in both. Perhaps they’re just very skilled surgeons in Poland to get the numbers so low?
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Here are a few videos of Dr Robert Tomas in Florida performing a Desarda repair
https://www.youtube.com/watch?v=FcN0T2KSJg0
https://www.youtube.com/watch?v=Mm6rBnTPQt8
And the same Dr performing the same repair on an enormous hernia that appears to contain internal organs:
https://www.youtube.com/watch?v=1IsuuD5keEI
The Desarda repair is certainly interesting but it’s relatively new, and I don’t think there have been any longterm studies done on the outcomes yet, both in terms of chronic pain and recurrence. I would also be very interested to see how the repair holds up with athletic individuals, and to other activity related, lifting, and lifestyle stresses over time. And what about using Desarda for mesh removal patients? Or Desarda outcomes for patients with chronic pain, or a very painful hernia? Hopefully there is a large study being done on Desarda to answer these questions and others, and hopefully Dr Tomas is keeping track of patients and their outcomes.
Some meta-analysis exists to compare Desarda with Lichtenstein (simple open mesh) but is not particularly informative for these questions:
https://www.ncbi.nlm.nih.gov/pubmed/28889330
https://www.ncbi.nlm.nih.gov/pubmed/29277678
I would also be very curious to hear other surgeons thoughts on the Desarda repair, particularly those who have extensive experience with no-mesh repairs and other open repairs.
And if anyone has a personal experience with Dr Tomas, or a Desarda repair in general, and would be willing share it here, surely others would appreciate reading it.
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I may be wrong, but I think Desarda is the only tension free, mesh free repair. It is my believe that it is one of the best mesh free repairs, if not the best. That is my opinion. Note that I am not a doctor nor a surgeon. I have had an asymptomatic inguinal hernia for about 8 years now. I never repaired it because my hernia is retractable and asymptomatic so I was able to live with it for good 8 years and I may continue to do so for another 8 good years. On top of that, I really resent the idea of using a plastic mesh inside my body. I don’t want a Coca Cola bottle in my groin, no thank you.
So I have been reading up on these alternative, more traditional approaches, and Desarda seems to be the next step in the evolution of mesh free repairs. That’s a very much welcome addition to this art. It really is an art. Any novice surgeon can patch up a hernia with a piece of plastic mesh at the expense of misery for the patient. Only a true master of the craft like Desarda, Bassini, Shouldice, et al, pass on a heritage and have a technique named after them with great outcomes for the patients.
Patient first! Profits last! In many healthcare systems the focus lies on cutting down costs, time, and decreasing re-operations. If patients complains of chronic pain, they just tell them its in their heads and hand them some painkillers. Who cares about a single individual? The larger collective comes first. Then there are also the companies that make mesh products. They are also in it to win it. It’s a billion dollar business for them. One which will only increase with growth of population and sedentary lifestyle. Then there are also the hospitals and insurance companies. Everyone is chasing the dollar. It is the harsh reality of things.
If I had to go for surgery tomorrow, and I had a choice, I would go for a mesh free, tension free repair. Be it Desarda, Shouldice or a combination of the two or other techniques.
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Dog-found this and it might be helpful to you
https://www.sportshernia.com/no-mesh-hernia-repair/repair/
this surgeon dr. Brown although he also specializes in sports hernias also specializes in no mesh hernia repairs and he breaks down the different techniques- shouldice, desarda bassini etc -
Unfortunately that can be hard to determine until the surgeon is actually in there. However based on your description of where the pain/discomfort is -it seems more likely to be a indirect hernia-if you do a giggle search you can see the location of the two types of inguinal hernias-direct and indirect. Ultrasounds can sometimes reveal which one you have it they are very operator dependent. MRI in the hands of someone who specializes in reading them-like dr. Towfigh who runs this forum may be able to tell. Not sure if a cat scan will aid in differentiating the two and of course maybe dr. Tomas or the surgeons and shouldice since this is all they see and do may be able to differentiate and tell which one you have. For me o was diagnosed with a indirect and when I had surgery the surgeon said I had both a direct and indirect which for me explained why I was in so much pain and discomfort and I actually felt it in two different albeit close proximity locations.
one surgeon told me all three type of growing hernia originated in a space not much bigger than a silver dollar-so that illustrates why sometimes the three can be hard to distinguish upon. By the way the third is a femoral hernia but they are much more rarer and even more rare in men.
hope this helps. -
Dear Jnomesh Thank You ! Good point ! after reading it i start to think that first to determine what type of hernia i have ? Could you please advise me on that..it so confusing :{ ….
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Hey Dog. When I said second to none I was referring to the statistics the Shouldice Hospital reports less than 1% recurrence rate and less than 1% chronic pain rate and I think I’m reslity both are like .06%. I haven’t seen anyone or place best those numbers mesh or no mesh.
but desarda approach is great to and I think dr. Tomas quotes very low recurrence rated too.
either method or facility seems great.
but you do bring up a great point regarding tailoring ones approach to what is exactly going on once they get inside. I know of a highly regarded surgeon dr. William brown in San Fran who doesn’t use mesh and says that the method he uses depends on what he finds once inside and hebtailors that approach accordingly. Still I know he doesn’t use the shouldice or desarda but kind of a modified bassini approach. The truth is most surgeons have a style or approach they are use to and confident in and that isn’t necessarily a bad thing as you want to have they surgeon specialize in what they do. I’ve watched videos of the shouldice repair and the Surgeons say wverubsurgery and person is different but they still use the shouldice repair but they have to make adjustments to this repair once they actually operate.
also to make matters more confusing if you search these threads you will come across a dr. Kang in South Korea who has developed his own repair for indirect hernias and he has stated that he believes the desarda repair is more suited for a direct inguinal hernia not a indirect hernia. I believe the shouldice repair covers and reinforced both spaces-I’m not 100% certain of this though.
bottom line I think you will be fine if you choose either approach with either facility. -
quote Jnomesh:It’s not only the technique but the surgeon performing the technique. Did not look at your link but dr. Tomas specializes in this technique and this is basically all he does.
the shouldice technique is a little bit more for lack of a better word “invasive” but it’s results reported seem second to none. Again you have to match the technique to the surgeon and the Shouldice Hospital is really only the best place to goto to get this done and done right.
i commend you in your path in seeking a non mesh repair!Jnomesh YEP!! Agree too much more “invasive” more stitches ..more getting deeply inside ,more tissue separations…more pain..more long term problems.. ….What do you mean “results reported seem second to none” ? Yep looking with NO mesh :}
What i am thinking some doctors who specializing in one method has tendency to use it for all cases..regardless ..like one method and tool fits all… :} This is a problem ! ..Dr Tomas is very confident and i believe is excellent but what if in my case more reasonable to use other method ?
Do you think that would better to check with doctor who use multiple no mesh methods … my hernia located very low on the side almost near testicle?
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It’s not only the technique but the surgeon performing the technique. Did not look at your link but dr. Tomas specializes in this technique and this is basically all he does.
the shouldice technique is a little bit more for lack of a better word “invasive” but it’s results reported seem second to none. Again you have to match the technique to the surgeon and the Shouldice Hospital is really only the best place to goto to get this done and done right.
i commend you in your path in seeking a non mesh repair!
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