What’s not to like about Desarda?
Hernia Discussion › Forums › Hernia Discussion › What’s not to like about Desarda?
- This topic has 21 replies, 6 voices, and was last updated 3 months, 2 weeks ago by William Bryant.
02/07/2023 at 5:04 pm #33785ChuckParticipant
Many on this forum dismiss the Desarda repair…and i am not sure why…I think it goes mostly to Dr Twofighs dismissal of the technique…Thunderrose would say oh i would never do desarda…watch it on video…then she made a sushi roll out of her abdomen with shouldice…Desarda leaves no junk inside, its a tension free repair, its not associated with chronic pain, its done under local in 15 minutes…the only downside is you gotta go to Tomas who will hit on your girlfriend….if i could do it over and kang was not an option…i think desarda is best
02/07/2023 at 6:24 pm #33786
I think people are just a little baffled by it since it’s a very different approach. It’s not nearly as well studied as Shouldice or mesh. Dr. Yunis really likes it. Some of the German surgeons like to use it in some cases.
I asked one surgeon who doesn’t like it so much, and he said that people with a weak posterior wall causing a hernia also tend to have a weak EOA (external oblique aponeurosis). A strip of the EOA is used instead of mesh in Desarda, so you need a good EOA.
I think this points to the big issue with tissue repair. It really needs to be tailored to the patient’s anatomy, tissue quality, type and size of hernia, etc. There are cases where Kang may be the best choice, or Desarda, or Shouldice, or in some cases mesh is the best option. Since pretty much no surgeon can do all of these well, such tailoring almost never happens in practice. Mesh may cause problems sometimes, but it’s an effective “one size fits all” solution. Tissue repairs aren’t really like that, not even the most extensive one which is Shouldice.
- This reply was modified 3 months, 2 weeks ago by Watchful.
02/07/2023 at 9:46 pm #33788Mike MParticipant
The two biggest issues in a “perfect” patient body scenario are:
#1. Repair tissue dying due to lack of blood flow.
#2. Minimium Length of recovery for a “strong” repair outcome (years).
This is my understanding from feedback from the leading tissue repair doctors mentioned on these forums and the limited research information previously posted on these forums regarding that specific repair.
02/07/2023 at 10:03 pm #33789
The blood supply thing was speculation by Kang. I asked Lorenz and Yunis (who both perform Desarda) about that, and they both said it’s not at all a concern, the strip doesn’t need much blood, and they’ve never seen such a problem happen.
I didn’t ask them about the time to recovery.
02/07/2023 at 11:40 pm #33791
In Germany Desarda repair was tried out and from I can gather was equal to established methods in this smallish study.
One other thing about Desarda is it is relatively easy to teach.
Dont forget Thunder Rose was very pleased with the Shouldice repair opted for Chuck.
Not sure how you two, Watchful and Mike M, get so much info from surgeons!? I find them hard to contact, except Dr Kang.
02/08/2023 at 7:16 am #33793
Thunder Rose did indeed report that she was happy with her Shouldice repair by Yunis. I recall she mentioned some issue, but considered it minor or part of the healing of the incision – I don’t remember exactly.
Most of these turn out fine it seems, but some (too many) don’t.
I haven’t found it hard to get an appointment or two either in person or by video with surgeons. You need to have all your questions ready. Sometimes (but not with everyone), you can have a couple of follow-up e-mails as well. Kang is actually harder because he doesn’t do video consultations, and doesn’t communicate directly by e-mail. You can only go through his assistant, or sometimes on this forum.
02/08/2023 at 8:01 am #33794
Did you have to pay for the consultations?
I can’t remember Thunder Rose having an issue but it may have been before I was a regular on here!!!
Another thing about the Desarda repair is it is, reportedly, easy or fairly easy for surgeons to learn so not sure why it’s not more readily available.
02/08/2023 at 1:48 pm #33801
I had to pay for consultations in the US, but not Germany.
Tissue repair for adult inguinal hernias is a tiny niche. It’s not just a matter of the level of difficulty of particular procedures. Mesh is considered the “gold standard”.
02/08/2023 at 3:09 pm #33802
I watched a video on YouTube with Dr Koch and he mentioned tissue strength being the drawback with the Desarda. It was towards the end of a 20 minute video. A guest of Dr Towfigh also mentioned that and Dr Towfigh agreed. it may have been the one with Dr Muschaweck.
Now this surprises me because the tissue in the video of Dr Desarda doing his operation looks much stronger than any transversalis fascia that I’ve seen used in Shouldice videos.
02/08/2023 at 9:11 pm #33804
I always understood tissue needs to be good for most tissue repairs, both Shouldice and Desarda. I’ve read recently a Desarda patient had a recurrence and that was solved by a second Desarda – so tissue must have been brilliant
I think Dr Kang is one of the few that can perform tissue repair when others can’t or won’t.
02/08/2023 at 9:16 pm #33805
I always thought the dominance of mesh Watchful was down to it being easier to perform than most tissue repairs as well as less recurrence.
I thought it took longer to train for Shouldice etc than mesh and greater anatomical knowledge was needed?
Maybe I got that wrong.
With reports showing Desarda is pretty much on a par with mesh for good results there must be a reason for it’s lack of uptake? Especially as of the tissue repairs it is allegedly easier to learn? Isn’t it?
02/08/2023 at 10:43 pm #33806
Watching the Desarda performed by Desarda, it doesn’t look difficult at all to learn.
Dr Koch actually said that he and another surgeon had helped to introduce the Desarda surgery in Germany, but that he preferred Shouldice because the tissue used in the Desarda was often weaker. Desarda uses the external oblique aponeurosis for the posterior wall reinforcement. In the video, it looks strong, but Desarda also characterized it in that operation as a good specimen.
Mesh being easy and quicker to perform probably has a lot to do with Lichtenstein being done versus Shouldice.A surgeon performing a Shouldice on YouTube gave that as the reason he mostly did mesh now. I think he said it was about twice as fast as the shouldice.
02/08/2023 at 11:52 pm #33807
Have you had any surgery David? Or are you thinking of it. I just can’t decide where or who or how.
Sometimes Dr Kang seems best.
Then people post his work is not well known or peer reviewed, not sure what that means actually.
Then Shouldice but dont fancy the waking up during cutting etc.
The Desarda – but cutting into good tissue!?
I’m not anatomically minded so I don’t know all the details as you and others do!
02/09/2023 at 1:07 am #33810
It means Kang’s results aren’t independently verified.
Waking up during surgery has nothing to do with the Shouldice procedure. It can happen in any surgery which uses light sedation, and patients report it with Kang as well. I think it’s still better than taking the damage and risks of deep sedation or general anesthesia. If it is noticed that you woke up in pain, sedation is increased.
Cutting into good tissue happens with all surgery…
02/09/2023 at 11:01 pm #33826
William, I haven’t had surgery yet. I guess I’m more or less in the same boat as you with my indecision.
I’m gonna reread the posts by Dr Kang, but I doubt I’ll go that direction. As honest as he sounds, I still would like to have more outside verification of the trustworthiness of his method.
I’ll probably rule out lap surgery. Calling it minimally invasive seems like a misnomer. Gall bladder lap surgery always sounded minimally invasive, because the opening sounds less invasive and nothing stays in. But with mesh, the mesh itself is the invasion of the tissues and scars up the the things it touches. Plus, I’ve had a heart attach and also have an irregular heart beat with some normalish bradycardia. I’m not in bad health,really, but those facts make me worry about the general anesthesia. Also, I’m trying to stay on the thin side and and have some worry about noticing the internal mesh due to that.
I would be leaning to the shouldice, but my hernia is probably direct and probably larger than normal. Makes me question my tissue strength. I also have some reluctance to have the cremaster dissected if it doesn’t appear that I have an indirect, as well. These two facts limit my willingness and accessibility to choose that.
Alas, I want to get it right and there is no path that I feel confident with.
02/09/2023 at 11:53 pm #33827
There is no perfect path, unfortunately. I didn’t feel comfortable with any of the options either, and waited until I practically had no choice but to have the surgery done. I don’t regret waiting, and I would have waited longer if it had been possible. The risk of trouble with this surgery is simply too high to do it unless you truly must in my opinion.
Once I had to pull the trigger on it, I picked based on a huge amount of research. I researched it in my spare time and talked to many surgeons for over a year once I knew watchful waiting wasn’t going to work for much longer.
Still, even after all that research, and making what seemed like a very solid choice, it hasn’t turned out great in my case so far, but I don’t know if it would have turned out better with another approach. My surgery would have been a lot easier with Lichtenstein than Shouldice, but who knows about complications beyond that.
02/09/2023 at 12:46 am #33809
Desarda hasn’t been studied extensively. There isn’t a critical mass of interest in tissue repair out there to change that picture. The few surgeons who practice it and are active at hernia conferences don’t consider it a one-size-fits-all (unlike mesh). It’s another tool in the tissue repair arsenal. Depending on tissue quality and the nature of the hernia, sometimes the patient is a good fit for that, sometimes for Shouldice, sometimes for neither. That’s not going to take over the world of hernia repair when mesh is so entrenched and so widely-applicable across patients. Also, even though Desarda is relatively simple for tissue repairs, it still requires training that surgeons can’t get almost anywhere these days.
I always liked the principle of the Desarda repair, and how much simpler and safer it seems when compared to most other techniques, particularly Shouldice. It’s still open surgery, so the disadvantages of that are still there, but the amount of dissection and stitching is so much lower, and the sutures can even be absorbable.
02/09/2023 at 5:13 pm #33819Jack2021Participant
From my research, I understand that Dr Light in the UK performs the Desarda repair under local anaesthetic without sedation.
I’ve not heard of any issues with this, though I’ve not managed to find reviews.
02/09/2023 at 6:03 pm #33820Jack2021Participant
With Dr Towfigh having talked about not rating the Desarda repair and Dr Kang seemingly not rating it either, it would be really interesting to hear what your opinions are @drtowfigh and @drkang regarding a couple of the studies published that appear to evidence that the Desarda repair is worth considering for low rates of recurrence and chronic pain and quality of life post repair.
I realise that other members have previously posted these studies, the first of which is the 15-year follow-up study in Poland where from 198 patients tracked down who answered all the questions:
‘After 15 years of follow-up, three recurrences were found (1.5%). Recurrences occurred 2, 3, and 5 years after the surgery. All patients expressed their satisfaction with the treatment. Twenty-eight patients (14.4%) reported a rare occurrence of mild pain while performing certain activities. Three patients reported persistent chronic pain (1.5%). Conclusion: Surgical repair of primary inguinal hernia using the Desarda technique is a simple, feasible, repeatable procedure, using the patient’s own tissues, and with a low learning curve.’
17 patients who were contacted didn’t answer all the questions and there’s no further detail or explanation about this. It would obviously have been helpful to know if their repairs had resulted in chronic pain/recurrence or not.
The other study is very recent and I believe posted by Good Intentions (apologies if it was someone else). Dr Ralph Lorenz, one of the hernia surgeons in Germany who specialises in the Desarda repair and a modified Shouldice repair, was involved with this study:
02/10/2023 at 5:06 am #33833
I’m pleased you linked to another Desarda study Jack as there seems to be a few that view it in a positive way. I put this in a thread “new study in Germany” I’m not sure if you saw it so here it is
I’ve yet to see a bad report but it’s still not caught on
02/10/2023 at 6:05 am #33837
David, thanks for the reply… Have you seen the article about the cyclist with a heart condition Dr Kang successfully operated on… It was one of the first articles I read about Dr Kang and it’s impressive. I’ll see if I can find it, I think the cyclist was called Peterson?
02/10/2023 at 6:07 am #33838
Oh it was Wilkerson… Heres article about him and Dr Kang
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