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Any News On Desarda Inguinal Hernia Repair?

Posted , 32 users are following.

abrogard
abrogard

I was diagnosed with double inguinal hernia a couple of years ago and have been on 'watchful waiting' ever since.

I studied quite a bit in the early months and got horrified and worried by all the stories of pain and complications after mesh and laparoscopic surgery.

I found Dr Desarda's technique and rather lurid web site and was very impressed in the finish.  His figures seem good. He has this immense benefit of no chance of mesh complications and the possibly equal benefit of not requiring extensive technical training on the part of the surgeon.

But I couldn't find a surgeon in Australia who would do it.

And the whole medical establishment in Australia, within and without the government - i.e. up to and including the Royal College of Surgeons and the Minister for Health - would do nothing, not the smallest thing, to even acquaint themselves with Desarda's technique, much less make it available to me.

Giving me a further reason to rely heavily on watchful waiting and hope for maybe a self healing.

Well no self healing has happened and I've never heard of any regimen that might promote it.

I now wonder what's happening with the world of patients and ex patients.

Anyone had the Desarda technique? Knowledge of it spreading? Is it becoming available?  Or has it gone backwards for some reason, found to be flawed?  Or laparoscopy improved?

Does anyone have any comment, any new information for me on this subject, please?

4 likes, 71 replies

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  • abrogard
    abrogard

    Edited

    Funny how this thing works.  I got an email about Jay1796 replying to my comment - came here to see his reply -it's not here!

    Perhaps he took it down.

    So while I'm here I might report that I'm due to have the laparoscopic operation in a couple of weeks.

    I am not convinced at all that it is the best, that the risks are not badly greater than open surgery because of the difficulties of removing mesh - but I've been persuaded that the risks are down at the 5% level either way.

    It is a gamble, seems to me.  And Desarda is simply not available to me in Australia.

    My surgeon has had an inguinal laparoscopic operation himself, he says. That's persuasive though perhaps logically it shouldn't be.

    Gets to the point where you (I) just can't follow logic any more.  The arguments get too similar on either side.  There's too many estimates and unknowns.  There's too much claim of superior knowledge on each side.

    It's like the global warming debate in that respect.

    But what I thought I might contribute for those who don't know about it, haven't got it, there is a Dr Desarda's Youtube video showing his operation very clearly.

    If you can watch this you'll see it is a very understandable and simple operation.  And then if you research just a little further and get an understanding of the 'mechanics' of it you'll be in a much better position to think about it all.

    Moderator comment: I have removed the link(s) directing to site(s) unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

    http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

    • LiammaiL
      LiammaiL abrogard

      Posted

      So your going to go Laparoscopic / mesh,? Getting inguinal hernai repaired is tricky business and its complications much underestimated.I personally would not have a repair done laparoscopically.The quality repair is more important than a cosmetic look or a few extra days in bed with longer or more pain. Open incision i believe is better and the surgeon has more control.

      Iv seen a few videos, Which one exactly are you referring too so I can check it out,

      It appears that if theres a reoccerence with Desarda its infinitelly more easier to fix it than the mesh.

      Cheers LiammaiL 

    • abrogard
      abrogard LiammaiL

      Posted

      Hi...

      yep, I'm surrendering is just about what it amounts to.  Not at all convinced it is the right thing but just about convinced that it is a margin call either way.

      That's about the way my surgeon put it - that recurrence rates are about the same - i.e. marginal.

      And that mesh complications are not now as they used to be.   Don't know how true that is.

      He pointed out - or maintained - that though it appears very simple in the video - only that one tricky bit of getting around that nerve I think it was - there must be more to it because it simply hasn't caught on all around the world.  He claims it is not as easy as it looks.

      And has the demerit of using  -  reusing - 'diseased' tissue.

      I was referring to the easily accessible youtube video of the Desarda method being used in an actual operation.  It has been up there for about four years I think that I know of.

      Did you see the moderator claimed to have removed my link because it was to a site 'unsuitable for inclusion' ?  God knows how they work that out.

      Anyway just google desarda repair youtube or similar.  It's almost as though everyone is against this knowledge getting out, isn't it?  I wonder if they'd have the same attitude to 'shouldice repair'  and so on?

       

  • manon66212
    manon66212 abrogard

    Posted

    I don't know what Desarda technique is, however, let me assure you that whatever it is, if mesh is used, you will end up in so much pain, you will not likely ever be the same...  whatever you do, find someone who will do it the old fashioned way.

    • abrogard
      abrogard manon66212

      Posted

      Hi...

      well you can google it. It is the best documented of them all - a video of the actual procedure, first one I've ever seen of an actual operation. And you can find pages where it is discussed, the rationale, etc,. and links to studies.

      It is not a mesh  procedure.  It is an 'open' procedure that employs a unique method of repairing the problem.

      I commiserate with you if you're experiencing much pain.  And I worry - because I am going to have laparascopic surgery in a week or so.  Because Desarda is not available in Australia.

      But my hope and belief is that at least 90% of laparoscopic surgery is succesful and without recurrence of the hernia and without complications. 

      That's what my surgeon has told me.

      And hernia operations are the most common form of surgery it seems.  Thousands of them performed every year.

      It would seem thousands of them are working fine.

      I sincerely hope so.   smile

  • abrogard
    abrogard

    Edited

    I couldn't see how to edit my recent reply so here's a new post.

    I thought perhaps some people might benefit from a simple view of what this Desarda thing is all about.  Years ago I drew a diagram for my own benefit and might help some to understand.

    I have just uploaded it and I see a thumbnail there so hopefully it'll be good.

    I can't seem to get beneath it to add comments so I'll add them here - a short explanation of what's happening.

    You'd realise that inguinal hernias are all about the inguinal canal?  That's why they're so named.

    It is an opening through the abdominal wall to allow passage of the spermatic cord and as such it is a potential weak point, a breach in the defences if you like.

    So this repair is all about fixing that.   Don't be put off by the strange words, they're simply medical names for muscles and tissues you've not met before.  You soon get used to them.

    Okay - with reference to the diagram:

    The eoa (external oblique aponeurosis) at the bottom end is continuous with or becomes the Inguinal Ligament.

    This is slit open horizontally above the spermatic cord

    Then the top part of it (the eoa) is taken down and behind the spermatic cord and sewn to the inguinal ligament, making a fresh wall behind the cord.

    This fresh wall is then slit at about that same place above the cord so that the  bottom edge of the slit can then be sewn to the Internal Oblique muscle above it.

    Making again the posterior wall but now fastened to the muscle above the cord instead of still being part of the exertanal oblique aponeurosis.

    Effectively a strip of the eoa has been detached and sewn at the bottom to the inguinal ligament and at the top to the internal oblique and all of it behind - posterior to - the spermatic cord.

    This leaves the eoa with a strip missing so the bottom edge of this space is pulled up and sewn to the top edge, closing it all up again.

    And the cord is now in a snugger bag with a few benefits ascribed to it that you can read about.

    My surgeon was suggesting a weakness in the procedure is that it uses diseased tissue.  I'm not sure what he means and I just assume he's referring to the EOA and IL  (all one, really, one merging into the other, see?).

    I think the surgeon cuts away excess or diseased stuff during the course of this operation but I'm not sure.  Check for yourself.

    There is an interesting little remark on the bmc surgery site discussing this technique where they say:

    quote:

    It is probable, as stated by Read [12] that some metabolic changes in the collagen metabolism in this area result in loss of strength of this connective tissue that loosens those structures or muscles from each other resulting in proportionate loss of their performance and protection.

    unquote:

    I am unable to find this reference but it is one of the few things I've seen that even hint at a reason for these hernias.  'metabolic changes in the collagen metabolism'.  Pretty vague but at least pinning it down to collagen.  I'd like to see more.

    There seems to be little effort being put into discovering the cause of this weakened tissue.  All effort goes into this 'patching' surgery.

    Anyway.  Hope some find this useful.

     

    • e77635
      e77635 abrogard

      Edited

      I had my Desarda repair this afternoon by Dr Tomas. I will provide an update in a few days as to recovery. Just lying in bed, surfing the net and watching tv

       

    • abrogard
      abrogard e77635

      Posted

      HI..  I replied to you saying I"d had my operation and I'd let you know whatever happens, etc....

       and I see here it says a moderator deleted it!

      No explanation.  No  notification.  And no justification that I can think of, at all. 

      That would be the second time such a thing has happened on these forums.

      I guess it is time for me to leave them, there's something badly wrong with them.

      want to get in touch try

      Moderator comment: I have removed the link(s) directing to site(s) unsuitable for inclusion in the forums. If users want this information please use the Private Message service to request the details.

      http://patient.uservoice.com/knowledgebase/articles/398316-adding-links-to-posts

      http://patient.uservoice.com/knowledgebase/articles/398331-private-messages

    • ianpb74
      ianpb74 e77635

      Posted

      Hi e77635,

      How are you?

      Just creating this account to check on how was your Desarda operation's result?

      In Auckland, I've a doctor who can perform Desarda and very keen to hear about the result being done in AU/NZ.

      I've a left inguinal hernia from the last 10 years and no problems so far, only it is getting bigger from the 1st time I had it.

      Appreciate your comments, cheers.

    • abrogard
      abrogard ianpb74

      Posted

      HI.. you're asking me?  But I didn't have a Desarda.  I was unable to get one and finally was persuaded, in any case, by my surgeon that possibly it wasn't as desirable as I'd thought.

      In the event - I might not have written it here because of the hassle I had with some moderator arbitrarily and without explanation or recourse removing a removing a post - I had two other operations.

      I had two hernias. Bilateral. Inguinal.  The left was given a laparoscopic mesh operation and that went well.

      The right was given a laparoscopic mesh treatment and it failed that same day.

      So the right was then given a Lichtenstein open mesh operation and that was/is good.

      When the right op failed the surgeon looked at it and commented that the hernia was so large that a Desarda wouldn't have been able to fix it in any case.  He knew I'd been (for years) wanting and waiting for an opportunity to get a Desarda.

      That was quite a revelation - don't you think?  That a surgeon, even after an operation, was not away of the size of the hernia and its suitability for this or that procedure?

      Quite illuminating.  I'd use it as a definite indicator that you should, we all should, take a keen interest in what is happening to us and what it is planned should happen to us.

      In fact, witness the failed operation, it wasn't suitable for laparoscopic surgery either.  But he was unaware of it that we might think.

      I hasten to add that I quite like that surgeon and I think he's a good surgeon and a good man.  But those are the conditions, the paradigms under which they work:  they can go to surgery without what you and I would consider to be 'full knowledge'.

      That same surgeon, prior to my operations, discussed Desarda with me and pointed out that in the years since I'd been interested there's been no growth in double blind studies, no overwhelming uptake of the procedure despite its apparent total fitness for use widely because of its simplicity etc..

      In fact, in all, a somewhat suspicious lack of world wide success for it perhaps.  Only perhaps.  But yes, perhaps.

      And, the surgeon said, speaking as a surgeon, it is not as easily learned as the video and text suggests.  Some surgeons take to it readily, he said, and some do not.

      Lastly I'd like to comment again on that moderator in this thread who removed my post.

      I consider his action unwarranted and unwise, improper.  If there were any inappropriate links the correct action would be to remove the links and send notification of that action.  Nothing remotely like that was done.

      We are talking here of threads concerned intimately with people's health and safety.  To interfere in those discussions in such an arbitrary and aloof fashion is the very antithesis of therapy.

      And though I don't remember what links were there I'm pretty sure they would have been nothing more than a link to Dr Desarda's video of his operation which link is very, very, very suitable for this discussion.

      I in fact suggest very strongly that anyone with an inguinal hernia view that Youtube video and get some appreciation of what is entailed in operating on an inguinal hernia.

      I wish you all the best.

       

    • robert36848
      robert36848 abrogard

      Posted

      I live in Australia and have been researching hernia repair as I need to have a bilateral hernia repaired. Others in our situation may find the following information helpful.

      As far as mesh free is concerned, there is one surgeon in Sydney that can perform a mesh free inguinal hernia repair. Dr John Garvey, who is a groin specialist that works on professional  athletes amongst others. His mesh free operation is a tension free tissue darn type as he calls it. He also can perform mesh removal.

      As has been mentioned else where, Dr Young in New Zealand uses the Desarda technique. Dr Young told me recently that he has now performed between 150-200 Desarda operations with one recurrence. Recurrence was to a farmer, post op 18 months, after lifting sheep.

      Lastly, Dr Kang, a surgeon from Gipum Hospital, South Korea . Dr Kang has performed about 6000 mesh free inguinal hernias with 0.5% recurrence rate. The focus of the Hospital's hernia center is now to focus more internationally and become the worlds number 1 hernia center, including surpassing the Shouldice clinic in Canada. Email communication is quick and English level is quite good.

      Unfortunately Australia itself lacks in mesh free hernia ops, hopefully this will change. 

      Rob 

    • frank_54871
      frank_54871 abrogard

      Posted

      Abrogard, just wondering how you're doing now?  I've got a right inguinal hernia that needs to be repaired; it's starting to get uncomfortable. No doctors anywhere close to me use anything but mesh. Hopefully you're recovering well.

  • johnmac54
    johnmac54 abrogard

    Edited

    Hi All

    Following up the debate on Desarda technique. I'm from New Zealand. I found deciding on the best hernia operation extremely difficult. I researched the subject for two years. Then my bilateral inguinal  acting up and I had to make a decision within a month. 

    I chose Dr Tomas in Florida some 15 months ago. Short answer, total success. Feel stronger there than ever before. Could have had Gerald Young do them here in Auckland, but at that time he'd only done a handful and I wanted someone experienced. Dr Tomas is a fantastic surgeon and very competent. I was awake (twilight) the whole way through, I could tell he was onto it 100%. Tomas is up to around 2500 now with 1% reoccurrence - hard to argue with those numbers and his experience. Especially if your hernias are tricky as mine were. Gerald Young is a very good surgeon too, now that he's done more operations the choice is harder.

    The entrenched medical system (status quo) is probably why Desarda hasn't taken off in NZ. However this is the same system who kept implanting women with mesh despite massive publicity for years on the ill effects. Women's mesh was only withdrawn 10 days ago.

    Hernia mesh definitely has issues, and there's no way of telling whether you will be lucky or not if you have mesh implanted. In my view, its much easier and better odds dealing with a Desarda re-occurance (1% chance) than deal with the complications of ill effects of mesh (25% chance). If mesh goes wrong, it can go terribly wrong and this can happen even after 20 years. Mesh is a lifelong implant. 

    Deciding on the best hernia operations is extremely difficult, there is no perfect solution, each has its pros and cons. I'm extremely happy with my decision today 15 months after my operation, but who knows about the future? 

    Meantime all I can do is wish anyone facing hernia surgery good luck and fast healing.

    John

    Auckland

     

  • brettsl
    brettsl abrogard

    Edited

    I am an Australian (currently living in Sri Lanka), and had an inguinal hernia and did a lot of online research and reading.  I chose not to have mesh repair and took a trip to Pune in India to have the Descarda non mesh repair from Dr Descarda.  Have to say, I was fairly nervous about the whole thing and worried I had taken a leap of faith way too far, to go with this technique - which I only knew of from info online.  Anyway, that was now 3 months ago and it all went well.  Was not really painful ever but rather only uncomfortable for some days here and there.  I was walking around in India (street photographing) for many hours at a time only 3 days after surgery and was quite capable (mind you, in retrospect that was probably overdoing it a tad).  I understand that the chance of the hernia returning is almost nil with this technique.  The hospital for the operation was ok - ish (it is India) but the surgery theatre was certainly clean, equipped and modern. Check out the Descarda site online.  I am just posting this in case anyone thinks its not legit.  It certainly is and I am a content customer.   If anyone would like any info about my experience with it all, just let me know.
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