Comparative Study between Benefits of Desarda Tissue Repair Over Conventional Lichtenstein Mesh Hernioplasty

INTRODUCTION

An inguinal hernia is the protrusion of the contents of the abdominal cavity through a defect in the inguinal region.^[1,2] Typically, inguinal hernias contain fat or a portion of the small intestine. In females, the hernia may also include part of the reproductive system, such as an ovary. When an inguinal hernia forms, part of the peritoneum (membrane lining the abdominal cavity) protrudes through the abdominal wall, creating a sac around it.^[3]

These hernias usually develop on one side of the groin, with a higher frequency on the right side than the left. Individuals with an inguinal hernia on one side may also develop a hernia on the other side.^[4]

In 2019, there were an estimated 32.53 million prevalent cases and 13.02 million new cases of inguinal, femoral, and abdominal hernias globally. This marked an increase of 36.00% in prevalence and 63.67% in incidence from 1990. Males accounted for 86% of the new cases, with a male-to-female ratio of 6:1. Most patients were aged between 50 and 69 years. India (2.45 million), China (1.95 million), and Brazil (0.71 million) collectively represented over one-third (39%) of new cases worldwide.^[5]

Surgical repair is the most common treatment for symptomatic inguinal hernias, and it can be performed using an open or laparoscopic technique. Desarda tissue repair and Lichtenstein mesh hernioplasty are two effective techniques for inguinal hernia repair, chosen based on postoperative outcomes, complications, and recovery speed.^[6] The Desarda technique, introduced in 2001, uses a strip of the external oblique aponeurosis, avoiding synthetic mesh complications such as chronic pain and foreign body sensations.^[7] This method often results in less postoperative pain and faster recovery. In contrast, the Lichtenstein technique is a mesh-based approach known for its effectiveness and low recurrence rates, but possibility of complications like chronic groin pain and infections.^[8]

Both techniques have similar recurrence rates of around 1-2% and comparable complication rates. However, Desarda repair generally offers quicker recovery and less initial pain. While both methods are effective, Desarda may be preferable for those seeking to avoid long-term mesh-related issues.^[9]

Considering the varying outcomes associated with these techniques, it is necessary to conduct a thorough evaluation of their benefits, particularly in terms of postoperative pain, recovery time, recurrence rates, and overall complications. Thus, this study aims to compare Desarda tissue repair and conventional Lichtenstein mesh hernioplasty for inguinal hernia.

Material and Methods

The present study was a comparative study conducted at the People’s Hospital, Bhopal. In this study, a total of 82 patients meeting the inclusion criteria were studied from March 2023.

Consenting patients above 18 years of age, diagnosed with an inguinal hernia, were included in the study. Patients unwilling to undergo mesh-based surgery were included. Those aged less than 18 years, absconded/LAMA cases, or those who denied consent were excluded from the study. The ethical approval was obtained from the institutional ethics committee prior to the initiation of the study.

The demographics and the history of the patients were collected. All patients underwent a standardized preoperative evaluation and were randomly assigned to.

RESULTS

A comparative study between Desarda Tissue Repair (Group-I, n=41) and Conventional Lichtenstein Mesh Hernioplasty (Group-II, n=41) Table 1 show the comparision of demographic characteristics with a significant age difference (51.56 ± 14.11 vs. 44.29 ± 12.76, p=0.02), but both groups were entirely male. There were no significant differences in the side of the hernia between the groups.

As shown in Table 2, their significant differences in systolic blood pressure (SBP) (p=0.04), hemoglobin (HB)% (p=0.003), and random blood sugar (RBS) (p=0.04), with Group-I having slightly higher SBP and HB% but lower RBS. No significant differences were found in BMI, diastolic blood pressure (DBP), respiratory rate, total leukocyte count (TLC), or SpO₂. Both groups had normal pulse rates.

In terms of complaints, which are summarized, Table 3 Group-I (Desarda Tissue Repair) had no cases of abdominal pain, nausea, or abdominal distension, while Group-II (Lichtenstein Mesh Hernioplasty) had three (7.32%) cases of abdominal pain and two (4.88%) cases of nausea. Constipation was seen in 13 (31.71%) patients from Group-I and 15 (36.59%) from Group-II. Fever and history of trauma were more common in Group-II patients. Both groups had 100% conscious/oriented patients.

Summarized in Table 4 Group-I showed better post-operative outcomes compared to Group-II, with significantly shorter duration of symptoms, surgery time, recovery time, and hospital stay. Overall, Group-A demonstrated quicker recovery and faster recovery times.

Pain intensity is shown in Table 5 Desarda Tissue Repair (Group-I) was associated with significantly less postoperative pain compared to Lichtenstein Mesh Hernioplasty (Group-II). Group-I had a lower mean VAS score (2.76 ± 2.02) compared to Group-II (4.88 ± 2.66, p=0.03), with more patients in Group-I reporting minimal pain (VAS score 0-3).

In a comparative study, summaried in Table 6 Desarda Tissue Repair (Group I) showed significantly fewer post-operative complications than Lichtenstein Mesh Hernioplasty (Group II). Wound infection, seroma formation, chronic pain, and loss of sensation were reported only in Group II, while Group I had no complications in 97.56% of cases. Overall, Desarda was associated with fewer complications (p=0.02), making it a safer alternative.

DISCUSSION

The present study found that the Desarda Tissue Repair group (Group-I) was older than the Lichtenstein Mesh Hernioplasty group (Group-II) (51.56 ± 14.11 years vs. 44.29 ± 12.76 years, p=0.02). Both groups had all males, and there was no significant difference in the side of the hernia. Group-I had a higher hemoglobin level (14.17 ± 1.05 vs. 13.31 ± 1.45, p=0.003) and slightly higher SBP (114.93 ± 3.69 vs. 113.36 ± 3.05, p=0.04). Other factors, like BMI, DBP, respiratory rate, SpO₂, TLC, and RBS, showed no significant differences between the two groups.

The results demonstrated that Desarda Tissue Repair provided better results than Lichtenstein Mesh Hernioplasty. It had shorter symptom duration, quicker surgery time, faster recovery, and a shorter hospital stay.

Desarda Tissue Repair demonstrated significantly fewer postoperative complications compared with Lichtenstein Mesh Hernioplasty (p = 0.02). Wound infection, seroma (9.77%), chronic pain (7.32%), and loss of sensation (4.88%) were observed only in Lichtenstein Mesh Hernioplasty. Additionally, 97.56% of patients undergoing Desarda Tissue Repair experienced no complications, while 73.17% of those undergoing Lichtenstein Mesh Hernioplasty were complication-free.

Tugave VB et al.^[10] found that the Desarda (D) group demonstrated significantly better outcomes than the Lichtenstein (L) group in terms of operative time (p = 0.001), hospital stay (p = 0.002), and return to basic activity (p = 0.03). Both groups showed similar postoperative complications (p = 0.14) and recurrence rates (p = 0.16). Additionally, pain scores at 24 h and 7 days post-operation were significantly lower in the D group (p = 0.001), though there was no significant difference in pain scores at 6 months (p = 0.24).

Verma N et al.^[4] found that the mean duration of surgery was comparable between the Lichtenstein and Desarda groups (p = 0.167). Postoperative pain was higher in the Desarda group during the early postoperative period (p = 0.07), but by the end of day 7, pain levels were greater in the Lichtenstein group (p = 0.03).

Similar findings were noted by B. Mehmood et al.,^[11] who found that Desarda Tissue Repair provided better outcomes compared to Conventional Lichtenstein Mesh Hernioplasty. Desarda Tissue Repair had significantly lower postoperative pain on the 7^th day (1.50 ± 0.50 vs. 2.00 ± 0.76, p = 0.003), a shorter mean hospital stay (2.66 ± 0.65 days vs. 3.09 ± 0.81 days, p = 0.02), a quicker return to work (10.81 ± 2.44 days vs. 14.09 ± 2.70 days, p = 0.0001), and a shorter mean operative time (40.38 ± 3.26 min vs. 45.09 ± 3.97 min, p = 0.0001). Both groups had low rates of SSI and seroma formation, with no hernia recurrences, suggesting that Desarda Tissue Repair offers advantages in recovery and postoperative comfort without compromising safety.

Sahay N et al.^[1] reported that postoperative pain scores were similar between Desarda Repair and Lichtenstein Mesh Hernioplasty. On POD 1, the mean scores were 4.57 (±0.65) for Desarda and 4.70 (±0.59) for Lichtenstein (p = 0.09). On POD 3, the scores were 2.4 (±0.83) for Desarda and 2.28 (±0.71) for Lichtenstein (p = 0.22). By POD 5, the scores were 1.11 (±0.90) for Desarda and 1.17 (±0.82) for Lichtenstein (p = 0.37). No significant differences in postoperative pain were observed between the two techniques at any time point.

CONCLUSION

From the results of the present study, it was concluded that Desarda Tissue Repair is a more effective and safer technique compared to the Lichtenstein Mesh Hernioplasty for inguinal hernia repair. Desarda repair was associated with shorter surgery duration, fewer complications, lower postoperative pain, and faster recovery. Thus, it is a preferable option, particularly to avoid mesh-related complications.