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

Year 2022, , 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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References

• 1. Rutkow IM (2003) Demographic and socioeconomic aspects of hernia repair in the United States in 2003. Surg Clin North Am 83:1045–1051 (v–vi)
• 2. Hernia Surge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
• 3. Lichtenstein IL, Shulman AG, Amid PK, Montllor MM. Thension- free hernioplasty.Am J Surg 1989; 157(2): 188-93.
• 4. Bande D, Moltó L, Pereira JA, Montes A. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg. 2020;20(1):147.
• 5. Rutegård M, Gümüsçü R, Stylianidis G, Nordin P, Nilsson E, Haapamäki MM. Chronicpain, discomfort, quality of life and impact on sex life after open inguinal hernia mesh repair: an expertise-based randomized clinical trial comparing lightweight and heavyweight mesh. Hernia. 2018;22(3):411-418.
• 6. Desarda MP. New method of inguinal hernia repair: a new solution. ANZ J Surg. 2001;71(4):241-244.
• 7. AmidPK .Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia .2004;8:1–7.
• 8. Ueda J, Nomura T, Sasaki J, Shigehara K, Yamahatsu K, Tani A, Shioda Y, Furukawa K, Uchida E. Prosthetic repair of an incarcerated groin hernia with small intestinal resection. Surg Today.2012 42:359-62
• 9. Gutlic N, Gutlic A, Petersson U, Rogmark P, Montgomery A. Randomized clinical trial comparing total extraperitoneal with Lichtenstein inguinal hernia repair (TEPLICH trial). Br J Surg. 2019;106(7):845-855.
• 10. Faessen, J.L., Stoot, J.H.B. &vanVugt, R. Safety and efficacy in inguinal hernia repair: a retrospective study comparing TREPP, TEP and Lichtenstein (SETTLE). Hernia 25, 1309–1315
• 11. Desarda MP. No-mesh inguinal hernia repair with continuous absorbable sutures: a dream or reality? (A study of 229 patients). Saudi J Gastroenterol. 2008;14(3):122-127.
• 12. Mitura K, Romańczuk M. Comparison between two methods of inguinal hernia surgery;Lichtenstein and Desarda. Pol Merkur Lekarski. 2008;24(143):392-395.
• 13. Kemal A., Bülent E., Hande K., Ersin T., Arif A., Osman D. Kasık Fıtığı Onarımında Desarda Yöntemi Selçuk Tıp Derg. 2014;30(1): 4-7
• 14. Eklund A, Rudberg C, Smedberg S, et al. Short-term results of a randomized clinical trial comparing Lichtenstein open repair with totally extraperitoneal laparoscopic inguina hernia repair. Br J Surg. 2006;93:1060–1068.
• 15. Bittner R, Sauerland S, Schmedt CG. Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. SurgEndosc. 2005;19:605–615.
• 16. Woodfield J, Deo P, Davidson A, Chen TY, vanRij A. Patient reporting of complications after surgery: what impact does documenting postoperative problems from the perspective of the patient using telephone interview and postal questionnaires have on the identification of complications after surgery?. BMJ Open. 2019;9(7):e028561.
• 17. Arslan K, Erenoglu B, Turan E, Koksal H, Dogru O. Minimally invasive preperitoneal single-layer mesh repair versus Standard Lichtenstein hernia repair for inguinal hernia: a prospective randomized trial. Hernia. 2015;19(3):373-381.
• 18. JacekSzopinski ,Stanislaw Dabrowiecki , Stanislaw Pierscinski , Marek Jackowski , Maciej Jaworski , Zbigniew Szuflet. Desarda versus Lichtenstein Technique for Primary Inguinal Hernia Treatment: 3-Year Results of a Randomized Clinical Trial.World J Surg (2012) 36:984–992
• 19. Bay-Nielsen M, Perkins FM, Kehlet H, for the Danish Hernia Database. Pain and Functional Impairment 1 Year After Inguinal Herniorrhaphy: A Nationwide Questionnaire Study. Annals Of Surgery 2001; 233: 1–7
• 20. Zwaans WA, Verhagen T, Roumen RM, Scheltinga MR. Factors Determining Outcome After Surgery for Chronic Groin Pain Following a Lichtenstein Hernia Repair. World J Surg. 2015;39(11):2652-2662.
• 21. Bande D, Moltó L, Pereira JA, Montes A. Chronic pain after groin hernia repair: pain characteristics and impact on quality of life. BMC Surg. 2020;20(1):147.
• 22. HerniaSurge Group. International guidelines for groin hernia management. Hernia. 2018;22(1):1-165.
• 23. Zieren J, Zieren HU, Jacobi CA, Wenger FA, Muller JM. Prospective randomized study comparing laparoscopic and open tension-free inguinal hernia repair with Shouldice’s operation. Am J Surg 1998; 175: 330-3.
• 24. Jensen EK, Bäckryd E, Hilden J, Werner MU. Trajectories in severe persistent pain after groin hernia repair: a retrospective analysis. Scand J Pain. 2020;21(1):70-80.
• 25. Sivarajah V, Farquharson B, Mahdi S, Cathcart P, Jeyarajah S. Chronic groin pain following open inguinal hernia repair: has consenting practice improved?. Ann R Coll Surg Engl. 2021;103(1):5-9.