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Page 8 of 10 Mitura et al. Mini-invasive Surg 2021;5:22 https://dx.doi.org/10.20517/2574-1225.2021.19

approach repairs, both with mesh and the use of patient’s tissues only.

The Desarda repair may be successfully used in all patients with a normal external oblique aponeurosis. It is
especially recommended in cases of surgeries on young slim men with lateral hernias with a narrow internal
[14]
ring . The procedure meets all conditions of modern hernia repair: it can be performed on a single-day
basis, it is possible to mobilize the patient early, patients may resume professional activities soon after the
procedure, only minimal pain is reported, there are no serious complications and recurrences, and a low
learning curve is observed [3,15] .

In some cases, this technique is not recommended in patients in whom the external oblique aponeurosis is
thinned and separating into fibers. The Lichtenstein surgery is preferred in those cases. Despite certain
technical limitations, the Desarda surgery seems to be a certain alternative allowing for hernia repair
without the use of mesh implants, especially with regards to the growing number of patients refusing use of
mesh. However, there are regions with limited access to modern mesh repairs, mainly in low-income
countries, where an effective and safe pure tissue repair may be the only accessible alternative to worldwide
recommended mesh repairs . However, there are many issues that have not been answered yet. Will long-
[16]
term results of these repairs be similar to, or perhaps surpass, those performed using the Lichtenstein
method? Will congenital defects in collagen structure, which are mentioned as the cause of hernia
[17]
pathogenesis, affect long-term results of this treatment ? The long-term follow-up results presented above
supplement the knowledge available in this field. However, the weakness of the study is a low percentage of
patients who were available for the long-term follow-up. Taking into account the 15-year follow-up period,
it seems that gathering more patients may be impossible, unless the results are entered into dedicated
central national medical registers.

There are several limitations to the present study. This study was a retrospective review of a single center’s
experience. Although it is possible that recurrence results could have been biased from progressive
variations, such as alterations in surgeon’s experience or other unaccounted for recognized practices, this
would be uncertain given surgeon workforce constancy, unchanged surgical practice, and established
postoperative pathways throughout the study time phase. Furthermore, patient’s sex and age, BMI, smoking
habit, and hernia type and size (the major determinants that might influence a recurrence rate) were all
similar between the patients included in the follow-up and the entire group of operated on patients.
Another possible limitation is the lack of personal examination. Although it was possible to invite some of
the patients for a face-to-face interview along with sonography examination, most. Patients were unwilling
to undertake a visit, making it unlikely to analyze the outcomes in a large group of patients. A third
limitation of our study was that the cohort was not compared with the results in a group treated with a
standardized technique (i.e., Lichtenstein repair). This likely reflects the fact that, during the initial
implementation of this technique in our center, Desarda repair was a predominant surgical technique used
for primary groin hernia repair in the analyzed time period. Despite the retrospective and descriptive
character of the study as its drawback, the main intention of the authors was to familiarize the readers with
the details of the surgical technique and to present long-term treatment results.

In 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. The results of
treatment of inguinal hernias using this technique allow for a low percentage of recurrences and chronic
pain in a long-term follow-up. It seems that the Desarda repair can still be a safe alternative to other non-
mesh surgical techniques, especially when the patient refuses the use a synthetic mesh.