COMPARISON OF LICHTENSTEIN AND DESARDA REPAIRS IN INGUINAL HERNIAS IN TERMS OF POSTOPERATIVE CHRONIC PAIN AND RECURRENS; A PROSPECTIVE RANDOMIZED TRIAL

Year 2022, Volume: 29 Issue: 3, 454 - 461, 30.09.2022

Ersin Turan , Kemal Arslan , Bülent Erenoğlu Ramazan Saygin Kerimoglu , Süleyman Said Kökçam Hande Köksal , Osman Doğru

https://doi.org/10.17343/sdutfd.1139412

Abstract

Objective
Patient comfort is an important factor affecting the
outcome and success of inguinal hernia repairs.
Mesh usage significantly decreases recurrence rate
however, the problems due to mesh usage negatively
affects the patient comfort. Desarda repair using the
body's own tissues has gained importance because
it is more physiological and has low recurrence
rates. In this study, we aimed to compare Desarda
and Lichtenstein repairs in terms of chronic pain and
recurrence.
Material and Method
Patients who were operated on at Konya Training
and Research Hospital between October 2010
and February 2014 were included in the study.
Randomization was done using the closed envelope
method. Desarda repair was performed in the first
group (D), and Lichtenstein repair was performed in
the second group (L). Both techniques were applied
as originally described. 3 questionnaires were
used in the assessment of chronic pain. All three
questionairres were filled before the operation, after
first and third year from the operation.
Results
162 people participated in the research. There
were 80 people in the Desarda group and 82 in the
Lichtenstein group. The median follow up time was
122 (96-145) months. There were 2 cases with
recurrence in each groups. Preoperative pain levels
were similar. The pain incidence, severity and limited
activity were similar in the first and third years. The
mean operation time was significantly lower in D
group than L group (44.5±3.7 min and 56.7±2.97 min
respectively). Complication rates were similar in both
groups.
Conclusion
Desarda technique can safely used for hernia repair
with its similar recurrance, complications and chronic
pain rates with the most commonly used Lichtenstein
technique. Moreover, it is advantageous with
physiological closure of myopectineal orifice, being
easy to perform, not containing foreign material and
being cost-effective.

Keywords

Inguinal hernia, Desarda repair, chronic pain, patient comfort., Lichtenstein repair

Supporting Institution

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Project Number

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Thanks

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KASIK FITIKLARINDA LİCHTENSTEİN VE DESARDA ONARIMLARININ POSTOPERATİF KRONİK AĞRI VE NÜKS YÖNÜNDEN KARŞILAŞTIRILMASI: PROSPEKTİF RANDOMİZE BİR ÇALIŞMA

Abstract

Amaç
Hasta konforu inguinal herni cerrahisinde başarıyı
belirleyen temel unsurlardandır. Mesh kullanımı nüks
sorununu ciddi şekilde çözmüş olsa da yeni bir sorun
olarak kronik ağrı problemini doğurmuştur. Desarda
tekniği eksternal oblik kas aponevrozunu kullanan
bir yöntemdir ve fizyolojiye uyguluğun yanında düşük
nüks oranları ile popülerlik kazanmıştır. Çalışmanın
amacı Desarda ve Lichtenstein tekniklerinin nüks,
kronik ağrı ve hasta konforu açısından karşılaştırılmasıdır.
Gereç ve Yöntem
Ekim 2010 ve Şubat 2014 tarihleri arasında Konya
Eğitim ve Araştırma Hastanesi Genel Cerrahi Kliniği’ne
kasık fıtığı şikayeti ile müracaat eden hastalar
çalışmaya dahil edildi. Hastalar kapalı zarf usulü ile
randomize edilerek 2 gruba ayrıldı. İlk gruba Desarda
prosedürü (D),ikinci gruba Lichtenstein prosedürü (L)
uygulandı. Her 2 teknik de orijinal tarif edildiği şekli
ile uygulandı. Kronik ağrının değerlendirmesinde kullanılan
anketler hastalara ameliyat öncesi, ameliyat
sonrası 1. ve 3. yılda uygulandı.
Bulgular
Desarda grubunda 80,Lichtenstein grubunda 82 olmak
üzere toplamda 162 hasta değerlendirmeye
alındı. Ortalama takip süresi 122 (96-145) aydı. Her
2 gruptan da 2 ‘şer hastada nüks gözlendi. Ameliyat
öncesi ağrı değerlendirmesinde gruplar arasında fark
yoktu. Yine ameliyat sonrası 1. ve 3. yılda ağrı şiddet,
sıklık ve hareket kısıtlılığında gruplar arasında
anlamlı fark yoktu. Ortalama ameliyat süreleri sırasıyla
44.5±3.7 dk. ve 56.7±2.97 dk. olmak üzere D
grubunda daha kısaydı. Fark istatistiksel olarak anlamlıydı(
p<0.001).Gruplar arasında komplikasyonlar
açısından anlamlı fark yoktu.
Sonuç
Desarda tekniği; dünya genelinde en sık uygulanan
ve yama kullanılarak gerçekleştirilen Lichtenstein tekniği
ile aynı seviyede nüks, kronik ağrı ve komplikas-
yon oranı ile güvenle uygulanabilir. Dahası onarımın
fizyolojiye uygun olması, yabancı cisim içermemesi,
kolay öğrenilip uygulanması ve maliyet avantajı olması
da yöntemin ek avantajlarıdır.

Keywords

Kasık fıtığı, Desarda onarımı, Lichtenstein onarımı, kronik ağrı, hasta konforu.

Project Number

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