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Prof. Dr. Desarda M. P. MS;FICS(USA);FICA(USA) respond to Great questions!
Q. Dear Prof. Dr. Desarda M. P. Did You and Your team improve method or made some changes in the procedure ?.{.it is about 10 years now when you start } if yes , Are you providing for doctors those new Recommendations/Updates ?
Answer by Prof. Dr. Desarda M. P.
I made my first and last improvement in operation technique when I operated on my second patient way back in 1985. Afterwards till today there is no modification or improvement in the steps of the operation technique
- From your experience ..what would you the Best Advice for doctors and patients to avoid long term chronic pain ? and expedite recovery using your method ?
Answer by Prof. Dr. Desarda M. P.
- Minimal handling and avoiding {pulling disturbing} of the spermatic cord, nerves { especially genitofemoral nerve } ,all vessels and preserve the cremasteric muscle fibers .
B. Very important …Clean and gentle dissection !
C. Use proper Aponeurotic part for suture .. to avoid recurrence through such improper suturesUsing correct steps of the operation technique will not have any increase problems with pain or sexual function.
Doctors can visit http://www.desarda.com/operation-technique for all updates. -
27 Replies
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drtowfigh thank YOU! also professor Desarda WOULD LOVE TO COMMUNICATE WITH YOU personally and become contributor ! please feel free to e/mail him.. desarda@gmail.com> many great DOCTORS already DID!
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I’d like to provide some alternative thoughts:
– a complete hernia ultrasound should be a dynamic study. That means pushing or bearing down and in many cases, asking the patient to stand, bend, rotate hips, etc. it’s not done so in most places in the US, which is why the false negative rate of ultrasounds here are so high (about 50% in our published study).
– type specific tissue repairs were historically what were done. Marcy is an example. We learned a century ago that type specific tissue repairs are not ideal and result in an adjacent Hernia occurring. The Shouldice is a more modern version of the tissue repairs, where both direct and indirect hernias are addressed. Dr Shouldice has also reported his femora hernia repair technique, which can be added to the typical Shouldice repair. This non-specific repair is perhaps one reason why it has the best outcomes among the different tissue repairs.
– I wish to hear and read more about the outcomes from various newer tissue repairs, including the Desarda, in peer reviewed journals and at our Hernia surgical conferences. It’s a major deficit that I see.
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quote drkang:If your hernia bullges eaily by cough or with a Valsalva on lying positon. yes it is very likely a direct type.
You are the BEST!
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If your hernia bullges eaily by cough or with a Valsalva on lying positon. yes it is very likely a direct type.
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quote drkang:Yes, dog is right.
Of course, in most cases, lying positon is OK for the ultrasonic exmanination for the inguinal hernia. However, standing position makes the exam easier and more precise even if the hernia sac is very small. And it makes the discrimination of the type of hernia easier as well.
Guess I should have asked for standing images, too. Mine is visible enough to get laying down if I perform a valsalva, so I suppose it was deemed unnecessary. Knowing type would be nice, though I’m willing to bet with 95%+ certainty that it’s direct.
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Yes, dog is right.
Of course, in most cases, lying positon is OK for the ultrasonic exmanination for the inguinal hernia. However, standing position makes the exam easier and more precise even if the hernia sac is very small. And it makes the discrimination of the type of hernia easier as well.
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UhOh! I believe just in standing position you can see problem more profound…My one bulging just that way .
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quote drkang:Hi dog,
That is why Desarda technique is one of the ‘one-fits-all’ repairs. Yes, if I were a Desarda doctor, I also would not do the ultrasound examination to diagnose the type of inguinal hernia before operation. As the repair will be the same anyhow. We do the inguinal sonography to check the type of hernia before operation. It shoud be done in standing upright position with Valsalva maneuver.
Out of curiosity, why is standing necessary? I ask because I recently went for an ultrasound but was laying down the entire time. Report was nonspecific about hernia type, but will be sending the images to a radiologist friend for some insights. Important thing was that sac contained fat only; no intestine.
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quote drkang:
Scar tissue has a weaker tensile strength than normal tissue. Hence, I do not believe it is a good idea to use additional absorbable sutures to sacrifice normal tissue and create additional scar tissue.
Thank you for explaining that to me!
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Hi dog,
That is why Desarda technique is one of the ‘one-fits-all’ repairs. Yes, if I were a Desarda doctor, I also would not do the ultrasound examination to diagnose the type of inguinal hernia before operation. As the repair will be the same anyhow. We do the inguinal sonography to check the type of hernia before operation. It shoud be done in standing upright position with Valsalva maneuver.
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Thank YOU ! Dear Dr drkang…. The doctor also said it is no different for him how to fix them .he would do the same Desarda method to fix both …?
By the way what tape of specific ultrasonic test do i need to order ? [h=1][/h] -
Hi dog,
Yes, correct. However, this is only my personal rule.
It is true that direct hernia and indirect hernia are located on opposite sides of the inferior epigastric vessels, which pass through the center of the inguinal floor. Although, in contrast to what you heard from a certain doctor, it is possible to almost accurately determine whether it is direct or indirect through ultrasound prior to surgery.
The only similarity between these two hernias is that they share the same name ‘inguinal hernia’ because they both occur in the inguinal canal. I personally believe that they are completely separate types of hernia, because not only do they occur on different locations, they have different occurring mechanisms.
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Hi dog,
Yes, correct. However, this is only my personal rule.
It is true that direct hernia and indirect hernia are located on opposite sides of the inferior epigastric vessels, which pass through the center of the inguinal floor. Although, in contrast to what youI’ve heard from a certain doctor, it is possible to almost accurately determine whether it is direct or indirect through ultrasound prior to surgery.
The only similarity between these two hernias is that they share the same name “inguinal hernia” because they both occur in the inguinal canal. I personally believe that they are completely separate types of hernia because not only do they occur on different locations, they have different occurring mechanisms.
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drkang Dear Doctor Kang, Thank YOU! It is just makes sense! So .. summarize … For Indirect absorbable sutures for Direct Not absorbable ..Correct ?
Also one doctor told me that the only differences between direct and indirect ..they just come on the opposite side of some kind of vessel :}? And You can’t tell differences unless you go in…tests before will not show …Is it true ?
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Hi UhOh! & dog,
To my knowledge, the majority of tissue repair methods to fix direct hernia causes tension. But Desarda repair seems normally not to cause tension in the floor of the Hesselbach triangle.
Most hernia surgeons unload their responsibility of inguinal hernia recurrence on tension. This is in fact the reason why the use of mesh prosthesis began; since by having prosthesis replacement tension can be prevented. It seems that Dr. Desarda agrees to the necessity of prosthesis replacement in order to prevent tension. Although, he seems to have designed a method that uses a strip of external aponeurosis instead of mesh to avoid mesh complications.
However, I do not believe tension is the decisive cause of inguinal hernia recurrence. Hence, I do not believe that the best way is to perform surgery in a way that focuses to prevent tension. As I consistently mention, I believe that the main cause of recurrence is because proper type-specific repair is not being executed.
Anyway, the majority of tissue repair methods with the exception of the Desarda technique induces tension. Thus, in my personal opinion, it is most desirable to use a material that can hold the sutured defect until it regains enough strength. Some suitable suture materials are non-absorbable Prolene or PDS, which is slowly absorbed. It has come to my knowledge that Shouldice Hospital uses steel. Although I have no experience using steel thread, I do not ever plan to use it because the above mentioned suture materials are sufficient enough. I am currently alternately using 2-0 PDS and 2-0 Prolene on my direct hernia patients and observing the operation results. When performing indirect hernia repairs, I am using 2-0 PDS.
As of now, for indirect inguinal hernia repair I believe PDS is sufficient, and for direct inguinal hernia repair I am going to use 2-0 Prolene until we get the results of the above mentioned comparative study.
Scar tissue has a weaker tensile strength than normal tissue. Hence, I do not believe it is a good idea to use additional absorbable sutures to sacrifice normal tissue and create additional scar tissue.
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Dr drkang Please respond..i think it is better then use proline suture..or metal wire OMG that will be there for life ?
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So here’s another question: If there is a legitimate question about tissue quality with a direct hernia, would adding additional absorbable sutures to the surrounding area promote additional scar tissue growth?
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quote drkang:Hi dog!
With frequent mesh complications, the necessity of tissue repair magnifies more and more. Desarda and Shouldice are no doubt big assets in the field of tissue repair, and I believe they are better than any mesh repair methods. But I do not believe that they are the best tissue repair methods with no need of further improvements. I am quite certain that there can be other tissue repair methods that are smaller in scale, simpler, and produce better results; and it is in the direction of type-specific repair.
I agree with Dr. Brown on many parts. However, we are different in the sense that Dr. Brown selects one among existing tissue repair methods in accordance to the individual’s conditions while I designed and am performing my own type-specific repair method that can be executed on all patients regardless of their conditions. Dr. Grischkan’s modified Shouldice method looks like mixing the Shouldice repair and mesh repair. I presume it is a type of mesh repair.
I have not yet presented my techniques to medical society as I had been continuously improving my procedures until several months ago. I am now accumulating my data to submit to a medical journal. It will take some more time. So there is no American doctor doing my procedure yet.
I’ve always been curious about what method(s) Dr. Brown actually uses. He talks about several established methods on his website, but also mentions that surgeons sometimes combine different elements of each, so I’ve often wondered whether he, too, has made extensive modifications, though prefers to simply keep them “in-house” rather than publish/teach them.
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Hi dog!
With frequent mesh complications, the necessity of tissue repair magnifies more and more. Desarda and Shouldice are no doubt big assets in the field of tissue repair, and I believe they are better than any mesh repair methods. But I do not believe that they are the best tissue repair methods with no need of further improvements. I am quite certain that there can be other tissue repair methods that are smaller in scale, simpler, and produce better results; and it is in the direction of type-specific repair.
I agree with Dr. Brown on many parts. However, we are different in the sense that Dr. Brown selects one among existing tissue repair methods in accordance to the individual’s conditions while I designed and am performing my own type-specific repair method that can be executed on all patients regardless of their conditions. Dr. Grischkan’s modified Shouldice method looks like mixing the Shouldice repair and mesh repair. I presume it is a type of mesh repair.
I have not yet presented my techniques to medical society as I had been continuously improving my procedures until several months ago. I am now accumulating my data to submit to a medical journal. It will take some more time. So there is no American doctor doing my procedure yet.
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Hi dog!
With frequent mesh complications, the necessity of tissue repair magnifies more and more. Desarda and Shouldice are no doubt big assets in the field of tissue repair, and I believe they are better than any mesh repair methods. But I don’t believe that they are the best tissue repair methods with no need of further improvements. I am quite certain that there can be other tissue repair methods that are smaller in scale, simpler, and produce better results; and it is in the direction of type-specific repair.
I agree with Dr. Brown on many parts. However, we are different in the sense that Dr. Brown selects one out of existing tissue repair methods in accordance to the individual’s conditions while I designed and am performing my own type-specific repair method that can be executed on all patients regardless of their conditions. Dr. Grischkan’s modified Shouldice method looks like mixing the Shouldice repair and a mesh repair. I presume it is a type of mesh repair.
I haven’t yet presented my techniques to medical society as I have been continuously improving my procedures until several months ago. I am now accumulating my data for reporting to a medical society. It will take some more time. So there is no American doctor doing my procedure yet.
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