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Learning about various techniques: Dasarda Technique versus Mesh surgery?
Hello,
I’ve had a small inguinal hernia, left side since September 2014. It is asymptomatic and doesn’t bring me any pain. Three doctors have examined me here in Oregon. Two at OHSU, one at The Oregon Clinic.
All three want to use Mesh. After reading data from doctors conferences and the plusses and minuses of mesh and post-op chronic pain or complications – I am about as likely to get a foreign body implanted in me, as I would to be shot out of a cannon! Not gonna happen. I’m a 7 days a week workout man; as I’m a fitness coach. My hernia doesn’t hinder my activity as a whole. I can feel pressure from it; it is small and only initially changed from being 1/4 of a golf ball when protruding from my flat lower abdominal/groin area, to now a stable 1/2 golf ball in size.
My hernia reduces easily when standing, laying or seated and never hurts.
However, I’m fully aware of the physiological aspects of hernias and they often do continue to protrude more so over time; it’s been 13 months since I initially noticed mine. I’m 5’9 and 161; fit, no medical issues and I sleep well.
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I’ve recently learned about the Desarda Technique and spoken to Dr. Robert Tomas out of Florida about his no mesh repair; by using the internal oblique muscle to strengthen the pelvic floor, reinforcing the inguinal canal region. I’ve watched the video, read studies about it and so on. Here’s Dr. Tomas’ website]What do you all think – I would like to know. Thank you in advance for your help. 🙂Dan
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4 Replies
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Learning about various techniques: Dasarda Technique versus Mesh surgery?
I’ve had the luxury of reviewing the Desarda technique with colleagues and mentors of mine that trained or taught in the 1950s and 1960s. They mentions to me that this technique fell out of favor then due to high recurrence rates.
It is not the Halsted technique. That uses the external oblique aponeurosis as a strength layer to the pelvic Floor closure, exteriorizing the spermstic cord.
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Learning about various techniques: Dasarda Technique versus Mesh surgery?
On a forum here, Dr. Towfigh dismissed Desarda technique (which I am imminently considering) as a rehash of 1950’s technique that failed. Can Dr. Towfigh specify that technique for me? Is it Halsted? (which Desarda seems possibly like), Or something else? I am imminently considering, but don’t want to be stupid. Desarda *does* have many good reports from patients who have used. Boston surgeons have suggested Desarda may just be Halsted revived. I want to know if this is the “1950’s” technique Dr. Towfigh was thinking of, or if something else, and if so, what the specific name was?
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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.
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Learning about various techniques: Dasarda Technique versus Mesh surgery?
Dan – Let me put it like this. I too am active, and fit. I know all about the risks of mesh, and have seen patients with mesh complications. They are however the minority, and when I got my hernias fixed, I had them done lap, with mesh. You’re free to choose whatever technique you want, and it is important you are comfortable with your decision. Hope this helps! DE
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