Non-mesh Repair of Inguinal Hernia: Desarda Versus Darn

NCT ID: NCT06712212

Last Updated: 2024-12-02

Basic Information

• Recruitment Status: ENROLLING_BY_INVITATION
• Clinical Phase: NA
• Total Enrollment: 30 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2023-03-01
• Study Completion Date: 2025-03-01

Brief Summary

To compare the results of Desarda and Darn techniques in inguinal hernia repair in Assiut University Hospital.

Detailed Description

Inguinal hernia is one of the most common types of abdominal hernias with a prevalence of 75% of all abdominal hernias. Inguinal hernia repair is one of the most encountered surgeries all over the world. The use of mesh for inguinal hernia repair is the most commonly applied technique. However, being a foreign body, mesh repair has its own disadvantages. These include Postoperative hematoma and seroma, foreign body reaction, infection, mesh rejection, mesh migration, and fistula formation. Moreover, the use of mesh in potentially contaminated operating field is not advisable. Infectious complication and their consequences have restricted the use of mesh in emergency settings. In addition, mesh repair is not available in every part of the world since it increases the cost of the operation. Therefore, the non-mesh repair of inguinal hernia has been recently revisited. Different techniques for non-mesh inguinal hernia repair are available including Bassini, Shouldice, Desarda and Darn. In 2001,Indian Surgeon Dr. Desarda, introduced a novel technique of a tissue- based hernia repair without mesh with almost zero recurrence rates in which an undetached strip of the external oblique aponeurosis is sutured to the inguinal ligament below and the muscle arch above, behind the cord, to form a new posterior wall. External oblique muscle gives additional strength to the weakened muscle arch to keep this strip physiologically dynamic. In 1948, Moloney described a suture inguinal herniorrhaphy in which two layers of continuous monofilament non-absorbable suture lines with no tension were inserted. The first suture line is between the lower edge of the internal oblique muscle/aponeurosis and the inguinal ligament. The second superficial layer is between the rectus sheath and the inguinal ligament. All sutures should be placed without tension but with no slack .

Literature are deficient in comparing Desarda technique and Darn technique in the repair of inguinal hernia.

Conditions

Inguinal Hernia Repair; Inguinal Hernia

Study Design

• Allocation Method: NON_RANDOMIZED
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: OTHER
• Blinding Strategy: NONE

Study Groups

Inguinal hernia

Group Type: ACTIVE_COMPARATOR

Inguinal Hernias repair: Desarda

Intervention Type: PROCEDURE

A splitting incision is made in this sutured medial leaf, partially separating a strip 1.5-2 cm wide. This splitting incision is extended medially up to the pubic symphysis and 1-2 cm beyond the abdominal ring laterally. The medial insertion and lateral continuation of this strip is kept intact. The upper free border of the strip is now sutured to the internal oblique with number 1 Monofilament Polydioxanone Violet continuous sutures all along its length. This will result in the strip of the EOA being placed behind the cord to form a new posterior wall of the inguinal canal. The spermatic cord is placed in the inguinal canal and the lateral leaf of the EOA is sutured to the newly formed medial leaf of the EOA in front of the cord. As before, number 1 Monofilament Polydioxanone Violet continuous sutures were used. Undermining of the newly formed medial leaf on both its surfaces and excision of the bulky cremasteric muscle facilitate its approximation to the lateral leaf

Inguinal hernia repair: Darn

Intervention Type: PROCEDURE

Skin and fascia are incised using a regular, oblique inguinal incision to expose the external oblique aponeurosis (EOA) the inguinal canal is opened into by dividing the external oblique aponeurosis through the external ring. After dealing with the hernia sac, a 0-size monofilament suture was used to reconstruct the inguinal bed with a tension-free darn starting with a good strong bite of the tough tendinous structures near the pubic tubercle and emerging out through the lateral edge of the internal oblique/rectus sheath from one side and through the inguinal ligament on the other side. The loosely interwoven bites continued laterally and the back-forming two rows of continuous stitches were placed in a staggered manner to spread the tension between the fibres of the inguinal ligament. Afterwards, the external oblique and other superficial layers with the skin are classically closed

Interventions

Inguinal Hernias repair: Desarda

A splitting incision is made in this sutured medial leaf, partially separating a strip 1.5-2 cm wide. This splitting incision is extended medially up to the pubic symphysis and 1-2 cm beyond the abdominal ring laterally. The medial insertion and lateral continuation of this strip is kept intact. The upper free border of the strip is now sutured to the internal oblique with number 1 Monofilament Polydioxanone Violet continuous sutures all along its length. This will result in the strip of the EOA being placed behind the cord to form a new posterior wall of the inguinal canal. The spermatic cord is placed in the inguinal canal and the lateral leaf of the EOA is sutured to the newly formed medial leaf of the EOA in front of the cord. As before, number 1 Monofilament Polydioxanone Violet continuous sutures were used. Undermining of the newly formed medial leaf on both its surfaces and excision of the bulky cremasteric muscle facilitate its approximation to the lateral leaf

Intervention Type: PROCEDURE

Inguinal hernia repair: Darn

Skin and fascia are incised using a regular, oblique inguinal incision to expose the external oblique aponeurosis (EOA) the inguinal canal is opened into by dividing the external oblique aponeurosis through the external ring. After dealing with the hernia sac, a 0-size monofilament suture was used to reconstruct the inguinal bed with a tension-free darn starting with a good strong bite of the tough tendinous structures near the pubic tubercle and emerging out through the lateral edge of the internal oblique/rectus sheath from one side and through the inguinal ligament on the other side. The loosely interwoven bites continued laterally and the back-forming two rows of continuous stitches were placed in a staggered manner to spread the tension between the fibres of the inguinal ligament. Afterwards, the external oblique and other superficial layers with the skin are classically closed

Intervention Type: PROCEDURE

Other Intervention Names

Desarda repair of inguinal hernia; Darn repair of inguinal hernia

Eligibility Criteria

Inclusion Criteria

• inguinal hernia
• Age more than 18
• Male patients

Exclusion Criteria

• simultaneous performance of other surgical procedures

• Minimum Eligible Age: 18 Years
• Eligible Sex: MALE
• Accepts Healthy Volunteers: No

Sponsors

Assiut University

OTHER

Sponsor Role: lead

Responsible Party

Akram Hamad

Resident General Surgery

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Assiut University

Asyut, Asyut Governorate, Egypt

Countries

Egypt

Other Identifiers

Inguinal hernia repair

Identifier Type: -

Identifier Source: org_study_id