New Desarda repair study from Germany

[Good intentions]

Dr. Lorenz is a co-author of this new, relatively small, study. The study results look promising, and, of course, the reason that the authors undertook the study. Maybe the tide is turning. At least there is some small pushback to the takeover of hernia repair by mesh methods.

The paper is kind of dense but still readable. I pulled out a couple of sections. Apparently TAPP is the primary repair method at their institution so they compared the results of the small Desarda group (120 patients) to the general results of the institution.

Many good references.

https://www.mdpi.com/2077-0383/12/3/1001

Quality of Life after Desarda Technique for Inguinal Hernia Repair—A Comparative Retrospective Multicenter Study of 120 Patients
by Mark Philipp 1,*,Matthias Leuchter 1,2ORCID,Ralph Lorenz 3,Eberhard Grambow 1ORCID,Clemens Schafmayer 1 andReiko Wiessner 4

“4. Discussion
Reasons for renewed interest in pure tissue repair for inguinal hernia are numerous. There are persisting concerns associated with implanted hernia meshes regarding chronic postherniorrhaphy pain, visceral complications following minimally invasive and mesh-based techniques, as well as long-term uncertainties toward later surgical procedures, e.g., radical prostatectomy [19,20,21].”

…

5. Conclusions
In an observational study to introduce the operation according to Desarda’s technique, we were able to show that the novel operation was successfully implemented. The results were equal, even in a low-volume prerequisite. This was underlined by an additional survey of the postoperative QoL, showing that Desarda was equal to TAPP and superior compared to the reference population.”

[William Bryant]

I never fully understand all these studies but to me it sounds as though they taught Desarda tissue repair to a number of surgeons which is a big step, I wish we taught tissue repair in the UK.

I also think it says recovery from initial pain was slower in Desarda group. This is the impression I have of tissue repairs in general and I’m sure it’s what Alan and watchful suffered.

It’s a bit ambiguous if, of the two people with persistent pain after Desarda, 1 had pre existing arthrosis or if this person was a 3rd.

Strangely a consultant I saw in UK and does tissue repair was a bit dismissive of chronic pain and said the patient may have had existing conditions like arthritis!

It’s encouraging that there is some acceptance of mesh causing chronic pain and tissue being an alternative!

By the way with mesh and chronic pain the mesh can be removed… What remedial steps can there be after a tissue repair?

[Watchful]

William,

It depends on the cause of the pain. If a nerve was damaged by the surgery, then nurectomy can be an option.

[William Bryant]

https://misjournal.net/article/view/4027

There’s quite a few studies ref Desarda, this one is a long term follow up. I’d appreciate the more intelligent posters views as I have trouble understanding these.

[William Bryant]

Thanks Watchful, I’m assuming it’s pretty much the same, nerve block, painkillers etc but you can’t undo a tissue repair like mesh can be explanted.

[Good intentions]

That is an interesting comment. It kind of implies that when the mesh is removed the tissues and hernia are all returned to the pre-implantation state.

Unfortunately that is far far from the reality. There is real tissue damage done during the implantation process and as soon as the foreign body response to the mesh begins. Despite how clean the blunt dissection of the pre-peritoneal space looks through the camera lens for TEP, or the neat peeling back of the peritoneum flap for a TAPP repair.

My lower abdomen, all of the area that was in contact with the nesh, is still stiff and distorted. It continues to get better over time, but the area is nothing like it was before the mesh implantation. Patients who have their mesh removed within months probably are closer to their original state than patients like myself who waited years. But the shrinking and stiffening occurs within weeks of implantation, as the body tries to destroy or encapsulate the mesh material.

There is no “undoing” of any of the repair methods. Many do minimal damage, like Dr. Kang seems to imply for his method. Others do intentional damage, cutting flaps and dissecting cremaster tissue, in order to effect a repair. But all of the repair surgeries do some sort of damage.

[William Bryant]

Oh yes I see what you mean, I didnt mean to be Insensitive or imply once the mesh is out it’s all fine. I know that people with mesh are pleased to get it out and usually say things along the line of I can walk better and without a stick for example. Which is far from perfect I realise but much better than they were with mesh inside.

I think Chuck went from pain and prostatitis to much improved. For example but still with issues.

I can see why Simon Bailey (Shouldice 2 or 3 layer) stresses chronic pain etc is still possible with tissue repair on his website.

[William Bryant]

Additionally Good intentions I’d be interested in your interpretation of the Desarda study linked to.

Is it saying in long term it’s a good repair?

[Good intentions]

They don’t say. I think that most surgeons are very short-sighted about the results of their work. It’s the nature of the profession. So much can happen to a patient after they leave and there will be so many over the course of a career, that unless they are truly interested in the long-term results of a procedure they just don’t follow up. It’s too much work and they have other patients waiting.

This is where the larger regulatory and public health institutions have a role.

[Author]

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