“Different types of groin hernia operations”

Hernia is a common disease that can affect any body from his childhood to old age. Operation is the only remedy to get relief from this disease. Patient will not mind to get operated if he is sure that he is going to be hernia free after surgery. But this does not happen in many patients because rate of relapse or reappearance of hernia at the same place is also quite high and unacceptable. Different surgeons recommend different operations to repair the hernia. Therefore, there is confusion in the mind of patients as to which operation they should prefer for their hernia surgery. This article gives details of different types of groin hernia operations done worldwide for knowledge of those patients.

Groin anatomy in hernia patients: All the vessels, lymphatics, vas, nerves along with their covers, together called as spermatic cord pass from abdomen to scrotum through inguinal canal. A protrusion of peritoneum called as hernia sac appears in this canal along with the cord and goes on increasing in size if this hernia sac is kept untreated. This canal and cord is normally protected by cover of two muscles behind and one muscle in front. The reason why hernia sac formation takes place is the weakness in those two muscles behind. This weakened spot in the posterior wall is called as weak spot or hernia hole. All traditionally done operations are designed to repair this hernia hole so that there is no recurrence of hernia after surgery.
There are two parts of hernia operations. First part is to separate the hernia sac and excise it. Second part is to repair this weak spot or hernia hole so as to prevent any recurrence in future.


Bassini Shouldice operation: In this operation patient is kept in the hospital for 2-4 days.
General or spinal anaesthesia is given. Hernia sac is excised. Then for repair of hernia hole, back two muscles are pulled down and sutured to the groin ligament. Surgeon takes several stitches so as to keep these pulled down muscles in place. There is tension on those stitches so patient has to take care for life time to avoid disruption of sutures. Unfortunately, this tension on muscles cause pain in groin area and prolonged rest needs to be taken to get relief and then only he can go to his routine work. There is more than 10% recurrence rate in this operation and increases with time because of contraction of the scar tissue adding more tension on the sutures. This results in more incidences of recurrences and groin pain. Repeat operation for recurrence or pain is difficult and bigger and the results are also far from satisfaction.

Some surgeons use another modification of this technique to reduce tension on the stitches. They suture back muscles and fascia in 4 layers. This reduces the tension on the muscles and sutures but for that many more complicated sutures are needed to be taken. Therefore, this operation can be done only by expert and specially trained hernia surgeons. This has brought down the recurrence rate but it has not totally disappeared. This operation is grouped under ‘tension repairs’ because there is tension on the stitches and muscles.

Mesh repair: In this operation no muscles are pulled down to cover the hernia hole. Instead, mesh is sutured on the weak spot to cover the hernia hole. This mesh is a piece of synthetic cloth just like a mosquito net and it is in no way some thing special. There is no tension on the stitches so this operation grouped under ‘tension free repair’. This has reduced the recurrence rate to a great extent (7-8% in USA) but it did not disappear completely. Reduced recurrences and simplicity of operation made it popular immediately all over the world. The mesh per se does not give any protection because it is delicate. But because it is a foreign body stitched inside, foreign body reaction starts and a tissue curtain is formed just like a corn following the thorn prick. This takes 4-6 months to form the curtain. It takes another 2-3 years to gain strength in this curtain. So, practically patient remains without protection for 2-3 years after surgery and if patient gets an attack of cough or sneezing during this period then there are increased chances of recurrence.
Contraction of this scar tissue adds more to the chances of recurrence. Involvement of nerves, vas or other structures in this scar formation results in to groin pain in 28 to 42% of operated patients. Tearing of sutures, disintegration of mesh, infection, migration are all noted complications. The mesh used by many surgeons is of low quality to save on the cost. Such meshes contract more than 50-60% naturally causing more recurrences. All above complications following mesh repair requires repeat surgery and this surgery is quite difficult and commanding even in the hands of hernia expert surgeons and the results are also poor.


Laparoscopic repair: This operation is done by inserting endoscopes inside by making 4 holes on the abdomen. General anaesthesia is given. Co2 gas is pumped in side the abdomen to inflate it. A much larger size of mesh is required to be stitched to cover the hernia hole from inside the abdomen. It is claimed that there is less pain following this surgery and patient can go to his work earlier. This operation can be done by inserting endoscopes to hernia site through abdominal wall instead of entering the abdominal cavity. This operation can be done only by experts in doing such surgery. More recurrences are seen if done by a novice surgeon. There are more risks involved in this surgery like general anaesthesia, pumping Co2, or trauma to intestines etc. Costly equipments, bigger mesh and expertise required to do this risky operation increase the cost of surgery.



Dr. Desarda repair: This operation is done by taking a cut on the skin. It is simple and does not
require any foreign body like mesh or any complicated instruments like endoscopes. A strip of a nearby muscle is separated and stitched on the weak spot to cover the hernia hole. There is no foreign body like mesh or no endoscopes are required therefore, this operation is free from all complications and risks that are associated with the mesh or laparoscopic repair. There is no tension on the stitches or muscles as seen in Bassini-Shouldice operation. Therefore, there are no complications and risks that are associated with the Bassini- Shouldice operation. Hernia hole is covered by a strong muscle. Therefore, protection starts on the operation table itself. Patient is admitted in the morning and immediately taken for surgery after preparation. Operation is done under local or spinal anaesthesia. No general anaesthesia is required. Operation is completed in 30 minutes and patient is back on his feet as soon as anaesthesia effect is gone. Patient goes to bathroom on his own within couple of hours and moves freely in the wards afterwards and is ready to get discharged same day night or next day morning. Patients are allowed to drive car and go to office, bend, squat, climb up the staircase or carry luggage and travel. All foreign patients coming to Indian Hernia Institute go back to their country on third day carrying their luggage and a journey of 20-22 hours without any difficulty. The most important quality of this operation is that there is virtually no recurrence or pain. This operation is spreading quite rapidly all around the globe and today it is being followed in many countries.



Interested patients and doctors can contact Dr. Desarda on his mobile no. 09373322178 or log on to his website http://herniasurgery.tripod.com

“Complete cure from hernia is now possible”

The president of “Indian Hernia Institute” and professor of surgery in Poona Hospital & Research Centre did extensive research in groin hernia disease and invented a new operation technique that gives almost complete cure from inguinal hernia disease. This technique is now known all over the world as “Dr. Desarda Repair”. Traditional operation techniques followed every where use mesh for hernia repair. This mesh repair is based on anatomical principle, whereas the new operation technique is based on the physiological principle. After a prolonged study of the anatomy and the physiology of the groin, Dr. Desarda has published in international journals new theories that are responsible for hernia formation. Since this operation corrects the basic pathology of the groin, there is no recurrence after his repair, Dr. Desarda claims.
Can any body give guarantee that there will not be recurrence after hernia surgery? The answer was “no” till today. But now, study did by Dr. Desarda and many other surgeons all over the world have proved that if this new repair is done then there are almost zero% chances of reappearance of groin hernia after surgery. Dr. Desarda uses a strip of a nearby strong muscle, instead of mesh, to repair the weak spot or hole of hernia. Dr. Desarda has already published many research articles about the results of this new operation technique in various international indexed journals. Many surgeons from other countries also did take study trials of this technique and published similar results.
Groin hernia repair was a challenge before the world because of its high failure rates. Uses of mesh for hernia repairs, introduced in market in 1990, have reduced this failure rate to 7-8% as per USA studies, but it is much more than this in India because of low quality mesh used to save the cost. Mesh is a foreign body like any synthetic cloth. So many complications associated with any foreign body like infection, pain or rejection also started revealing after mesh repair surgery. At this time in year 2001, Dr. Desarda put his new theory before the world that if groin hernia repair is done on physiological principle using your own body muscle and not done on anatomical principle, as is done in mesh repairs, then you can give complete cure from the hernia to the patient.

Dr. Desarda has operated on more than 1500 patients till today by this new technique and all of them are well and without any recurrence till today. This operation does not require general anesthesia, it is done under local or spinal anesthesia. Patient is admitted in the morning and taken for surgery immediately after preparation. Time required for surgery is average 30 minutes and patient can be on his foot as soon as anesthesia effect is gone. Normally patient goes to pass urine on his own within 4-5 hours and he is freely mobile in the wards same day night or next day morning ready to get discharged and go home. There are no restrictions on his movements or food intake. He can drive car and go to office, can climb a staircase, can carry luggage and travel, squat and sit down without much pain within 2-3 days. He is asked to carry his normal routine work as soon as possible and as per his tolerance. So, patient gets high level of satisfaction after this new operation technique. All my patients coming from USA or other countries are discharged on 3rd day. They all carry their luggage and travel for 20-22 hours by air to their country without any problem, Dr. Desarda says. The most important quality of this operation is that there is virtually no recurrence or pain. This operation is being followed in many countries all over the world.

Interested patients and doctors can contact Dr. Desarda on his mobile no. 09373322178 or log on to his website http://herniasurgery.tripod.com

“Why hernia re-occurs again and again”

When some part of our body leaves its original place and enters in to other cavity or comes out on the body surface then we call it as a hernia formation. Operation is the only remedy to get relief from this disease. Patient will not mind to get operated if he is sure that he is going to be hernia free after surgery. But this does not happen in many patients because rate of relapse or reappearance of hernia at the same place is also quite high and unacceptable. Mesh, which is a piece of synthetic cloth, was introduced in the market in 1990 for use in hernia repairs. We stitch a small piece of cloth to repair our torn shirt. Same principle is used in mesh repairs where in this mesh is stitched on the weak spot or hernia hole to give protection and prevent recurrence. Relapse rate or failure rate after groin hernia surgery has come down to 7-8% in USA after every body started doing hernia surgery by using a mesh, but it failed to give complete cure.
Majority of the hernias, almost 99%, are external and seen on the body surface and majority of them are seen on the abdominal wall. Amongst them, the groin hernias are seen in almost 75% of patients. But in India, proportion of other abdominal wall hernias like umbilical, epigastric, ventral or incisional hernia is also quite high. Our intestines are kept in a delicate balloon like bag in side the abdomen and protection is given by 3 layers of muscles all around them. When these muscles get damaged at some spot then that becomes a weak spot or hernia hole from where hernia formation takes place. This damage can happen due to surgery or stretching due to pregnancy or ascitis or they get weakened due to aging or some other disease.

In all traditionally done hernia surgeries, hernia sac is excised and a mesh is stitched on this weak spot or this hernia hole in an attempt to give protection to the weak spot and prevent relapse or recurrence. But this does not happen immediately after surgery because this mesh is delicate like a mosquito net. Then why it is stitched if it does not give protection? A foreign body reaction sets in and around the mesh and tissue penetrates in it to form a delicate curtain on the weak spot. This takes couple of months and then it takes another 2-3 years to get sufficient strength in it to give protection. It means the patient is not fully protected for 2-3 years in spite of mesh surgery. If patient gets an attack of cough or sneezing or some such other instance during this period then this mesh gets torn or stitches get torn or mesh moves away from the stitched place and relapse of hernia takes place. Another important reason for more relapses or recurrences seen in India is the low quality mesh used to save on the cost. This low quality mesh shrinks by 50-60% in side the body. Naturally there is increased tension on the sutures due to this shrinkage that tend to break beyond certain limits inviting hernia recurrence. Mesh shrinkage or mesh migrations are well documented complications inviting failures after the mesh surgeries. All hernia surgeries are done by hernia experts or consultants in USA, but, paradoxically in India, hernia surgeries are dedicated to the resident doctors who are not expert in hernia surgeries. This is also one of the important reasons for high rate of hernia recurrences in India.
A story of 38 year old Mr. David from USA is worth listening. He had left groin hernia since 2 years. He consulted with 2-3 consultants and hernia experts in Los Angeles, All of them had said that they will repair his hernia with a mesh. As is done by every American, David also did his own thorough search on the internet to get more knowledge about groin hernias. He found that almost 30 out 100 patients operated with mesh had suffered either from recurrence or chronic groin pain or infection or mesh migration in to the abdomen. These patients had undergone either open surgeries or endoscopic surgeries. So he started search to find out whether there is any centre which does hernia surgeries without using mesh. To his amazement, he found only two such centre all over the world. One was Shouldice centre in Canada and another was “Desarda Centre” in Pune from India. During his further search, he found that Shouldice centre use stainless steel wires to sutures and there is 1-2% of recurrence. So he chose Desarda Centre and came here to our Indian Hernia Institute to get his hernia set right. This story did not end with David, but many more patients from USA, France, and Australia etc have visited our centre for their hernia repairs. The main reason why every body now prefers to come to our centre for his hernia repair is that we do not use any foreign body like mesh. Therefore, no complications are seen in our repairs that are associated with mesh. We use a strip of near by strong muscle to cover the weak spot or hernia hole. Therefore, protection starts on the operation table itself. And patient gets almost complete cure without any fear of relapse or recurrence in future.

Dr. Desarda has operated on more than 1500 patients till today by this new technique and all of them are well and without any recurrence till today. This operation does not require general anesthesia, it is done under local or spinal anesthesia. Patient is admitted in the morning and taken for surgery immediately after preparation. Time required for surgery is average 30 minutes and patient can be on his foot as soon as anesthesia effect is gone. Normally patient goes to pass urine on his own within 4-5 hours and he is freely mobile in the wards same day night or next day morning ready to get discharged and go home. There are no restrictions on his movements or food intake. He can drive car and go to office, can climb a staircase, can carry luggage and travel, squat and sit down without much pain within 2-3 days. He is asked to carry his normal routine work as soon as possible and as per his tolerance. So, patient gets high level of satisfaction after this new operation technique. All foreign patients coming to Indian Hernia Institute go back to their country on third day carrying their luggage and a journey of 20-22 hours without any difficulty. The most important quality of this operation is that there is virtually no recurrence or pain. This operation is spreading quite rapidly all around the globe and today it is being followed in many countries.

Interested patients and doctors can contact Dr. Desarda on his mobile no. 09373322178 or log on to his website http://herniasurgery.tripod.com

“What is mesh used in hernia surgery?”

Hernia is a common disease that can affect any body from his childhood to old age. We need to stitch the shirt if it is torn, like wise we have to do surgery to get relief from this disease. Many times a small piece of cloth is used to repair the torn shirt, like wise this mesh is used to cover the weak spot of hernia or the hernia hole to repair it.
If your surgeon tells you that he will use a piece of your shirt or any other synthetic cloth after getting it sterilized for stitching on the hernia hole then you will never agree to his proposal. No body can think of this idea because you are sure and afraid that a piece of cloth can not be stitched inside your body and to do so is inviting lots of problems and trouble for your life time. You are aware that even if you take out the thorn, a small particle of it remaining inside the body forms a big corn, it pains for years and gets infected any time even after years.
Then what is mesh that is used routinely by almost all the surgeons during hernia operation? Every body imagines that mesh must be some special material prepared by the companies for hernia surgery and it must be safe in all respects for our body. In reality, it is not so. It is a simple cloth prepared from synthetic threads of polypropylene, polyethylene or prolene or some other such synthetic material. If companies had made it known to all that this is a piece of synthetic cloth then no body would have accepted it for use in hernia surgery. Therefore, it was named with a special name like “Mesh” and sold in the market. A big cloth is prepared from those synthetic threads. Then it is cut into pieces of various sizes and shapes and then it is nicely packed, sterilized and then sold in the market at exorbitant price. It is estimated that companies are selling those meshes worth Rs. 1000 crores every year in India alone.

The mesh which is used today was brought in the market somewhere during 1990. But such meshes prepared from Dacron or Teflon were already used in many patients all over the world much before that. A famous surgeon from Pune, late Dr. Sulakhe and the author himself did use such pieces of cloth like Terene, Terylene etc available at that time around 1970-75 after due sterilization in many patients. But such operations were already rejected by the surgical community because of unacceptable rate of infection following its use in hernia surgery. In reality, those old meshes and today’s mesh both are prepared from synthetic threads and technically there is no difference between them. But because of improved sterilization techniques and availability of better and higher antibiotics after 1990 reduced this infection rate to a great extent and therefore its use in hernia surgery became rapidly popular. Another reason for this was the high rate of recurrence following hernia surgeries done with old techniques. But this does not mean that now there is no recurrence of hernia after it is repaired by using this mesh. Recurrence is still there following mesh repair and it is 7-8% in USA as per their studies. Though recurrence rate and infection rate is substantially brought down, another major problem following mesh repair of chronic groin pain still remains and it is 28-42% as per many studies.

Your shirt becomes alright as soon as it is stitched but this does not happen when this mesh is stitched on the weak spot or hernia hole. The mesh is a delicate cloth just like a mosquito net and therefore fails to give immediate protection following the surgery. A foreign body reaction starts in and around the mesh and a curtain of tissues is formed within couple of months just like a corn following thorn prick. Then it takes another 2-3 years for developing sufficient strength in this curtain so as to give real protection against reappearance of hernia. It means the patient is not protected for 2-3 years in spite of hernia surgery with mesh. And if he gets an attack of cough or sneezing etc. during this period then the mesh gets torn or displaced or stitches get avulsed resulting in reappearance of hernia. This mesh can also get crimpled or retract to a size that is 20-50% less increasing chances of recurrences. This is seen in many more cases in India because the mesh routinely used in hernia is of low quality to save on the cost. Therefore, the rate of recurrence seen in India is much more than what is seen in USA.
These mosquito net like meshes when used for hernia repairs have made lives of many patients miserable. Many patients from USA and other countries have posted on the internet hernia forums their story of miserable life after mesh repairs. Specialists and specialty clinics are established in USA who does the only job of removing the mesh or treating the chronic groin pain syndrome. Recurrence, infection or pain following mesh surgery requires much larger, difficult and commanding operation to take out the mesh again for getting relief.
“Dr. Desarda Repair” is a new invention by Dr Desarda from Pune, which is a groin hernia operation without mesh. A strip of a strong near by muscles is stitched on the weak spot or the hernia hole instead of mesh. Therefore, protection starts on the operation table itself. This operation does not require general anesthesia, it is done under local or spinal anesthesia. Patient is admitted in the morning and taken for surgery immediately after preparation. Time required for surgery is average 30 minutes and patient can be on his foot as soon as anesthesia effect is gone. Normally patient goes to pass urine on his own within 4-5 hours and he is freely mobile in the wards same day night or next day morning ready to get discharged and go home. There are no restrictions on his movements or food intake. He can drive car and go to office, can climb a staircase, can carry luggage and travel, squat and sit down without much pain within 2-3 days. He is asked to carry his normal routine work as soon as possible and as per his tolerance. So, patient gets high level of satisfaction after this new operation technique. Dr. Desarda has operated on more than 1500 patients till today by this new technique and all of them are well and without any recurrence till today. All foreign patients coming to Indian Hernia Institute go back to their country on third day carrying their luggage and a journey of 20-22 hours without any difficulty. The most important quality of this operation is that there is virtually no recurrence or pain. This operation is spreading quite rapidly all around the globe and today it is being followed in many countries.
Interested patients and doctors can contact Dr. Desarda on his mobile no. 09373322178 or log on to his website http://herniasurgery.tripod.com

No mesh inguinal hernia repair-A story of Mr.David from USA

A STORY OF MR. DAVID FROM USA LOS ANGELES IS WORTH LISTENING:
Mr. David said that he did not wish to insert a foreign body like mesh in his body for hernia repair. He had heard from his friends and well wishers and also read and learnt from the internet about complications of a foreign body or mesh and the chances of recurrences after mesh repair. He made an immense research on the internet for any available technique of hernia repair that does not use mesh. He found to his amazement that there are only two centers all over the world which specialize in pure tissue repair of hernia. One is ‘Shouldice center’ in Canada and another is ‘Desarda Center’ in India. This is how he came to know about ‘Desarda’s Repair’ while searching on internet and liked it because it is without mesh or any foreign body and virtually free from recurrences thereafter.
David Williamson, a 37 years patient from Los Angeles, USA came to Pune to Dr. Desarda for getting operated for his groin hernia. Mr. David flew from USA and reached Mumbai and then Pune at 4AM in the morning on 7.10.2007. He was operated at 11 AM in Poona Hospital on the same day and was allowed to move out of bed and go to bathroom within 4-5 hours after surgery. He was permitted to move freely all around as and when he wanted. There were no restrictions. He was freely moving all around the ward on second day. He came down the staircase on third day with his hand bag luggage, took auto-rickshaw and went on his own to ATM centre to withdraw the money. On 4th day he went to Rajneesh Oschio Ashram and spent whole day there to attend there various course activities. A local patient is discharged from the hospital on the same day or next day morning and he is advised to attend all his routine work without any restrictions thereafter.
The story of Mr. Ted and Mr. Ron who also came to India for their hernia surgery is also similar to this story. If American surgeons had adopted this technique in their practice, many patients like David who wish to have no foreign body inserted for hernia repair could get easily operated there and could avoid this long distance journey and other hassles of going to some other country for such operation.
“Complete cure from groin hernia is now possible with Dr.Desarda's repair technique.......”
Mesh is a foreign body. Therefore, its use in hernia repairs is known to cause all sorts of complications like pain, recurrence, infection etc. We have developed an innovative new technique of inguinal hernia repair without mesh. It uses your own body muscle for repair and gives virtually complete cure from inguinal hernia problem. An undetached strip of the external oblique aponeurosis is stitched on the weak area between the muscle arch and the inguinal ligament to form a new, strong and physiologically dynamic posterior wall that gives protection and prevents re-herniation. Normally patient goes home in a day after surgery and can drive car and go to office in 3-4 days time. This "Dr.Desarda's hernia repair" is now followed in many countries all over the world. We are surprised to see the enquiries from many patients in the developed countries asking for this repair in their country. This is because this operation does not use any foreign body like mesh for repair and therefore there are no complications that are seen in mesh repairs. A visit to Topix or other hernia forums show thousands of posts showing sufferings of many patients due to mesh repairs. But still why surgeons from developed countries are interested in mesh repairs is a big question for us.
Please visit our website for more details: http://herniasurgery.tripod.com Our cell number: +91 9373322178