Prof. Dr. Desarda M. P. MS;FICS(USA);FICA(USA) respond to Great questions!

Hernia Discussion Forums Hernia Discussion Prof. Dr. Desarda M. P. MS;FICS(USA);FICA(USA) respond to Great questions!

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    • #11454
      dog
      Participant

      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

      1. 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.

      1. 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 sutures

      Using 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.

    • #16806
      dog
      Participant

      Hi UhOh It is from Prof. Dr. Desarda M. P. to you ! I wish to add a response to the comment posted by UHOH for his defect specific repair.

      “Suppose, patient has a posterior wall of inguinal canal of about an 3” IN LENGTH and the defect Is in any 1” part. According to him, he will close or repair that defect only and would leave other part as it is. Then there are many chances that again another defect might develop in the remaining part resulting into a fresh hernia. SO THE PRINCIPLE OF TREATMENT IS ALWAYS RECONSTRUCT THE ENTIRE POSTERIOR WALL THAT IS STRONG AND PYSIOLOGICALLY DYNAMIC TO GIVE LIFE LONG PROTECTION as is done in our repair. Therefore, we say our repair can be applied to any fresh hernia irrespective of its type or stage or size.”

      He also very pleased with our forum..as very nice and healthy “UNBIASED” …He expressed opinion that many posts seen on the different forums are biased in favor of mesh or the technique surgeon is interested in)

      I totally Agree with him! He is excellent surgeon and great person! Dog .

    • #16807
      UhOh!
      Participant

      Thanks for sharing that! I suppose I should have been more specific (as both Dr. Kang and Dr. Brown are) about using “defect-specific” repairs; they are talking about direct vs. indirect (and Dr. Brown also mentions femoral). It appears that Dr. Desarda’s answer is speaking mostly to direct hernias of different shapes, sizes and locations, based on his answer.

      His answer doesn’t appear to address indirect hernias in as specific a way as Drs. Kang or Brown (Dr. Kang has his own repair; Dr. Brown referees the Marcy repair). As those doctors explain it (or at least as I understand it), it is an entirely different type of defect, and even if a reinforcement repair like Desarda would patch it up, it still leaves the fundamental problem unsolved.

    • #16811
      drkang
      Participant
      quote UhOh!:

      Thanks for sharing that! I suppose I should have been more specific (as both Dr. Kang and Dr. Brown are) about using “defect-specific” repairs; they are talking about direct vs. indirect (and Dr. Brown also mentions femoral). It appears that Dr. Desarda’s answer is speaking mostly to direct hernias of different shapes, sizes and locations, based on his answer.

      His answer doesn’t appear to address indirect hernias in as specific a way as Drs. Kang or Brown (Dr. Kang has his own repair; Dr. Brown referees the Marcy repair). As those doctors explain it (or at least as I understand it), it is an entirely different type of defect, and even if a reinforcement repair like Desarda would patch it up, it still leaves the fundamental problem unsolved.

      Hi UhOh!,

      I completely agree with you. From what I know, the Desarda method is a more suitable method for direct inguinal hernia. If you watch a YouTube video of the Desarda procedure for indirect inguinal hernia, you can see that more than half of the surgical procedure is a process of reinforcing the Hesselbach triangle.

      Doctors widely claim that the reason for disregarding the specific type of inguinal hernia and rather repairing the entire inguinal area is to prevent the recurrence of another type of hernia later on. Thus, they claim that if only indirect is repaired, direct hernia can later occur, and vice versa. However, there are not any detailed evidence to support this claim. This is because there were not any opportunities to gain the outcome of type-specific repairs in the first place since all the surgeries were “one-fits-for-all” repairs.

      Despite, the key here is not to dispute but to regard the actual results. The recurrence rate of previous “one-fits-for-all” repairs came out to be between 10 – 30% and that of recent mesh repair stand by near upto 10%. How could these numbers be explained?
      Perhaps that type-specific repairs could be in fact more helpful in reducing reoperation possibilities. Such questions triggered the beginning of my development of type-specific repair. And the results from my personal experience came in accordance to support the fact that type-specific repair noticeably reduces the recurrence rate. Another merit of type-specific repair is that the extent of surgery is less than half of pervious surgeries. As the extent is reduced, it means less surgery injuries, less aftereffect, and quicker recovery. Each of these merits cannot be disregarded. Thus, “one-fits-for-all” repairs, in order to prevent a slight possibility of what hasn’t occurred yet, operate on unnecessary areas and cause unnecessary injuries to all patients being treated.

      Another surprising thing to me is that Dr. Desarda, in his reply, mentioned that he made his first and last improvement in operation technique when he operated on his second patient. This is just amazing because it took me 4 years and 11 months to first set my eyes on type-specific tissue repair and develop a final method, which by that time was at the very end of 2017, after operating my 5,000th patient. I have come to a stage where I feel self-satisfied of an almost impeccable method every time I treat a patient. However, that does not mean there will absolutely be no changes in the future. For even for a seemingly tiny improvement, adjustments should be made.

      Thank you!

    • #16813
      UhOh!
      Participant
      quote drkang:

      Hi UhOh!,

      I completely agree with you. From what I know, the Desarda method is a more suitable method for direct inguinal hernia. If you watch a YouTube video of the Desarda procedure for indirect inguinal hernia, you can see that more than half of the surgical procedure is a process of reinforcing the Hesselbach triangle.

      Doctors widely claim that the reason for disregarding the specific type of inguinal hernia and rather repairing the entire inguinal area is to prevent the recurrence of another type of hernia later on. Thus, they claim that if only indirect is repaired, direct hernia can later occur, and vice versa. However, there are not any detailed evidence to support this claim. This is because there were not any opportunities to gain the outcome of type-specific repairs in the first place since all the surgeries were “one-fits-for-all” repairs.

      Despite, the key here is not to dispute but to regard the actual results. The recurrence rate of previous “one-fits-for-all” repairs came out to be between 10 – 30% and that of recent mesh repair stand by near upto 10%. How could these numbers be explained?
      Perhaps that type-specific repairs could be in fact more helpful in reducing reoperation possibilities. Such questions triggered the beginning of my development of type-specific repair. And the results from my personal experience came in accordance to support the fact that type-specific repair noticeably reduces the recurrence rate. Another merit of type-specific repair is that the extent of surgery is less than half of pervious surgeries. As the extent is reduced, it means less surgery injuries, less aftereffect, and quicker recovery. Each of these merits cannot be disregarded. Thus, “one-fits-for-all” repairs, in order to prevent a slight possibility of what hasn’t occurred yet, operate on unnecessary areas and cause unnecessary injuries to all patients being treated.

      Another surprising thing to me is that Dr. Desarda, in his reply, mentioned that he made his first and last improvement in operation technique when he operated on his second patient. This is just amazing because it took me 4 years and 11 months to first set my eyes on type-specific tissue repair and develop a final method, which by that time was at the very end of 2017, after operating my 5,000th patient. I have come to a stage where I feel self-satisfied of an almost impeccable method every time I treat a patient. However, that does not mean there will absolutely be no changes in the future. For even for a seemingly tiny improvement, adjustments should be made.

      Thank you!

      This is why I plan on being very selective in terms of who I seek a repair from (eventually, if necessary), and why I’m insisting on imaging first (which I’ve now scheduled). I care most about a repair type I’m comfortable with, but care just as much that the surgeon is also comfortable doing it!

      Out of curiosity, have you had any surgeons from the U.S. come to Korea to learn your method yet? Intercontinental travel isn’t feasible for me at present, and part of the reason I’m waiting is that it seems like more and more doctors are starting to learn new tissue-based repair methods as patient demand grows.

    • #16824
      dog
      Participant

      “Defect specific” word is not applied to direct or indirect typing of hernia. Defect specific treatment means treat only that hole and leave other area as it is.

      Because, direct or indirect or femoral types have their own established treatments like mesh or Bassini or Marcy or Shouldice etc.

      UhOh! [h=2]Prof. Dr. Desarda M. P. Kindly Responded to your concern ..please read above[/h]

    • #16829
      drkang
      Participant
      quote dog:

      “Defect specific” word is not applied to direct or indirect typing of hernia. Defect specific treatment means treat only that hole and leave other area as it is.

      Because, direct or indirect or femoral types have their own established treatments like mesh or Bassini or Marcy or Shouldice etc.

      UhOh! [h=2]Prof. Dr. Desarda M. P. Kindly Responded to your concern ..please read above[/h]

      Hi dog,

      Just as how umbilical hernia and inguinal hernia are different, femoral hernia and inguinal hernia are completely different hernias. Many doctors use a different repair method for femoral hernia to that of inguinal hernia (however, in the case of laparoscopic mesh repair, mesh is usually covered on the whole area where indirect, direct, and femoral hernia can occur). Therefore, when discussing type-specific repair, it is better to regard only indirect and direct inguinal hernia.

      As Dr. Desarda pointed out above, the term ‘defect specific’ can cause misunderstanding. This is why I think it is preferable to use the term ‘type-specific’. Type-specific repair means that the whole area of each indirect and direct type is repaired.
      From the mentioned surgeries, Marcy is a type-specific repair for indirect hernia; meaning that it is not applicable for direct type inguinal hernias. Unfortunately however, only a tiny fraction of doctors are currently using this method for indirect inguinal hernia. Aside from this method, if we were to classify the Bassini, or Shouldice, or Desarda repairs, they lean more towards the direct type. Nonetheless, these methods are being used in all cases without consideration of type; whether indirect or direct. Among open mesh repairs, Lichtenstein mesh repair falls with the likes of Bassini kind of repair since it is used type-nonspecifically.

      Therefore, the intention of insisting type-specific repair is to encourage the use of an ideal method for each indirect and direct hernia instead of Bassini or Shouldice-like ‘one-fits-for all’ repairs. However of course, it is very rare at the moment to find hernia surgeons who agree with this. So I believe it will be sufficient enough for you to simply be aware that such assertion exists as well.

    • #16833
      dog
      Participant

      drkang Dear Dr. Kang, first of all i would like to tell you thank you! for your time you found out your busy schedule to respond to this very unbiased forum .I am not doctor but by watching different no mesh hernia repairs i become a big fan of Dr. Desarda M. P method for simple and common inguinal hernia .It is just makes sense ..i found Shouldice is extremely complex that would take amazing accuracy in handling almost like an oculoplastic surgeon…i don t think we can find so many surgeons with these brilliant qualifications …. I didn’t see your method video..would love to watch ?
      Do you have any doctors in America who do your method?
      Well dr Brown tells his opinion about
      Which Type of Hernia Repair is the Best? https://www.sportshernia.com/no-mesh…repair/repair/

      Also have you heard about updated Shouldice ? Here is info you can go step by step! Doctor claim it is more easy way? http://herniasurgeries.com/treat1.htm What do you think ?

    • #16857
      drkang
      Participant

      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.

    • #16858
      drkang
      Participant

      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.

    • #16862
      UhOh!
      Participant
      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.

    • #16878
      UhOh!
      Participant

      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?

    • #16879
      dog
      Participant

      Dr drkang Please respond..i think it is better then use proline suture..or metal wire OMG that will be there for life ?

    • #16880
      drkang
      Participant

      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.

    • #16881
      dog
      Participant

      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 ?

    • #16882
      drkang
      Participant

      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.

    • #16883
      drkang
      Participant

      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.

    • #16884
      dog
      Participant

      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]

    • #16886
      drkang
      Participant

      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.

    • #16889
      UhOh!
      Participant
      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!

    • #16890
      UhOh!
      Participant
      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.

    • #16892
      dog
      Participant

      UhOh! I believe just in standing position you can see problem more profound…My one bulging just that way .

    • #16895
      drkang
      Participant

      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.

    • #16896
      UhOh!
      Participant
      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.

    • #16897
      drkang
      Participant

      If your hernia bullges eaily by cough or with a Valsalva on lying positon. yes it is very likely a direct type.

    • #16901
      dog
      Participant
      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!

    • #16905
      drtowfigh
      Keymaster

      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.

    • #16913
      dog
      Participant

      drtowfigh thank YOU! also professor Desarda WOULD LOVE TO COMMUNICATE WITH YOU personally and become contributor ! please feel free to e/mail him.. [email protected]> many great DOCTORS already DID!

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