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Mitura et al. Mini-invasive Surg 2021;5:22 https://dx.doi.org/10.20517/2574-1225.2021.19 Page 5 of 10

made, cutting parallel to the course of fascia fibers, parallel to the inguinal ligament, passing through a
possible rupture in the aponeurosis (the place where the iliohypogastric nerve passes). In this way, an
aponeurotic strip and a medial flap of the external oblique aponeurosis are formed [Figure 2E]. The medial
aponeurotic flap is later used to close the inguinal canal. In the next step, the medial edge of a newly formed
lateral aponeurotic strip is secured with a continuous suture to the underlying internal oblique abdominal
muscle, using the same material as above [Figure 2F]. In this way, an aponeurotic strip is obtained which is
attached to the inguinal ligament on one side and to the internal oblique abdominal muscle on the other
side. It extends upward to the distal part of the aponeurosis and downwardly attaches in the region of the
upper ramus of the pubic bone [Figure 2G]. This strip strengthens the posterior wall of the inguinal canal,
similar to the polypropylene mesh in the Lichtenstein method. The inguinal canal is then closed by suturing
the remaining flaps of the fascia with absorbable suture over the spermatic cord/round ligament, typically
reconstructing the superficial inguinal ring [Figure 2H and I]. Single stitches on the subcutaneous tissue and
the skin complete the procedure.

Statistical analysis
The results obtained during the study were subjected to basic statistical analysis in Microsoft Excel 16.45.
Descriptive analysis included the calculation of average values, standard deviations, and proportions.
Bivariate analysis was done using Pearson’s Chi-square and Fisher’s exact test for categorical variables as
applicable, and t test for continuous variables. A value of P < 0.05 was considered a statistically significant
difference between the compared groups. All calculations were performed using the Statistica 13.0 licensed
statistical analysis software package.

RESULTS
In total, the elective repair according to a Desarda procedure was performed in 341 patients. Fifteen years
after the surgical procedure, a phone call follow-up was successful in 215 (63%) patients, of whom 198
(58.1%) answered all of the questions. The characteristics of treated patients and the procedure performed
are summarized in Tables 1 and 2. There were no relevant statistical differences between the respondents
and the total population of operated on patients. In the early perioperative period, minor postoperative
complications were found in 5.6% of patients, all of which resolved spontaneously without additional
surgical intervention. After 15 years of follow-up, three recurrences were found, which constituted 1.5% of
the patients who answered the questions [Table 3]. Recurrences occurred 2, 3, and 5 years after the
treatment, respectively. Nevertheless, all patients expressed their satisfaction with the treatment. Twenty-
eight patients (14.4%) reported a rare occurrence of mild pain while performing certain activities, but at the
same time they emphasized that this is not a phenomenon that hindered their everyday functioning. Three
patients reported persistent chronic pain (1.5%).

DISCUSSION
There is a common consensus that, after Lichtenstein repair procedures, the percentage of observed
complications and the number of recurrences are similar for procedures performed by both experienced
[8]
surgeons and residents . This is largely the result of a short learning curve characteristic for the procedure.
Simplicity of this operation favors the speed of its performance and similar results are achieved both by
centers specializing in hernia surgery and small surgical departments. A similar situation seems to be the
case with the Desarda surgery. Many common features between these two techniques (i.e., exactly the same
anatomical structures need to be dissected in both methods) lead to the conclusion that, as with the
Lichtenstein surgery, the Desarda method is lacking a troublesome complexity. Usually, duration of the
surgical procedure reflects the scale of difficulties of individual surgical techniques in inguinal hernia
repairs. The lack of statistically significant differences in the duration of procedures using the Desarda and