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

[dog]

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 ?

[drkang]

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.

[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]

[UhOh!]

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 5,000^th 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.

[drkang]

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 5,000^th 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!

[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.

[dog]

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 .