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Page 2 of 10 Mitura et al. Mini-invasive Surg 2021;5:22 https://dx.doi.org/10.20517/2574-1225.2021.19

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. 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.

Keywords: Inguinal hernia, Desarda technique, pure tissue repair, recurrences, follow-up

INTRODUCTION
Inguinal hernias are a widespread pathology and every fourth man in his life will be affected by this
[2]
[1]
pathology . Introduction of a polypropylene mesh was a milestone in the hernia repair . Currently, the
most frequently used method is the Lichtenstein repair with the use of an implant strengthening the
[3]
posterior wall of the inguinal canal . Techniques based on the use of the patient’s own tissues (pure tissue
repairs) are currently losing importance due to the possibility of securing hernia with a material of known
and durable strength - the polypropylene mesh . Only the Shouldice method still finds supporters and the
[4]
long-term results of this method used by experienced surgeons are similar to those of the Lichtenstein
method . A main disadvantage of the Shouldice method is its specific degree of complexity, which means
[5]
that only some surgeons perform the procedure in a fully correct manner with creation of all four layers of
[3,5]
reconstructed tissues .

[6]
An alternative to both of these methods was proposed in 2001 by an Indian surgeon - Desarda . He
described a method of repair which took into account the biomechanical aspect of the inguinal canal . A
[6,7]
bilaterally pedunculated strip of the external oblique aponeurosis is used to strengthen the posterior wall of
the inguinal canal [Figure 1]. As a consequence, and contrary to the Shouldice method, tissues of the
[7]
transverse fascia, which were initially weakened due to a disturbed collagen structure, are not used . The
strip is not separated at both its poles, which that it is included in the dynamic system of forces and stresses
occurring in this area. Tension of the abdominal muscles causes the strip of aponeurosis of the external
oblique muscle of the abdomen to tighten and expand, simultaneously pressing the posterior wall of the
inguinal canal and strengthening the area of the deep ring .
[7]

The aim of the study was to retrospectively analyze long-term results of surgical treatment of patients
diagnosed with primary inguinal hernia up to 15 years after a Desarda repair surgery. An additional aim of
this work is to discuss technical aspects of the presented procedure in detail.

METHODS
Patients
The study was conducted on a group of adult patients with primary inguinal hernia who underwent elective
surgery at our center during 2005-2006. All patients operated during this period were qualified for the
Desarda repair procedure on the basis of typical indications for the surgical treatment of inguinal hernias, in
accordance with current surgical guidelines. Only elective procedures were included in the analysis. Patients
with recurrent and strangulated hernias were excluded from the study. It was assumed that patients in
whom the external oblique aponeurosis was observed intraoperatively to be significantly thinned or
separated into fibers were not eligible for the Desarda surgery, but during the 2-year observation period no
patients were excluded for this reason. Surgical procedures were performed by the same team of surgeons.
Patients were operated on under regional anesthesia or, in the event of contraindications to this type of
anesthesia, under general anesthesia. All patients received thromboprophylaxis 12 h prior to surgery
(enoxaparin). All patients were preventively treated with a prophylactic dose of an antibiotic 30 min prior to