Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Mansoura Faculty of Medicine, Mansoura University, Mansoura, Egypt.
Int J Surg. 2015 Aug;20:28-34. doi: 10.1016/j.ijsu.2015.05.055. Epub 2015 Jun 11.
The ideal operation to treat inguinal hernia is still far to define. We analyzed the outcomes of the Desarda tissue-based repair in comparison with the standard Lichtenstein procedure in treatment of primary inguinal hernia.
A total of 168 patients were randomly allocated into two groups to undergo one of two repairs: Desarda (group I) or Lichtenstein (group II) (85 vs. 83, respectively). The primary outcome measures were recurrence of inguinal hernia and chronic groin pain. Secondary outcome measures included operating time, postoperative pain scores, time to return to normal gait and to work, foreign body sensation in the groin, and postoperative complications.
During 2-year follow up, one recurrence was detected in each group (P = 0.99). Chronic groin pain was experienced by 5.6% and 4.2% of patients from Desarda and Lichtenstein groups respectively (P = 0.68). There was no significant statistical difference in mean postoperative VAS scores for pain at the five time points between the two study groups. There was significantly shorter operating time and earlier return to normal gait in favor of Desarda repair. Foreign body sensation was not different between the two groups.
Successful inguinal hernia treatment without mesh implantation can be achieved using Desarda repair, as it is effective as the standard Lichtenstein procedure. Shorter operating time, early return to normal gait and lower cost (no mesh) are potential benefits of Desarda repair. The suitability of Desarda repair for patients found to have thin, weak or divided external oblique aponeurosis intraoperatively needs further evaluation.
治疗腹股沟疝的理想手术方法仍有待进一步明确。我们分析了基于组织的 Desarda 修补术与标准的 Lichtenstein 手术治疗原发性腹股沟疝的结果。
将 168 例患者随机分为两组，分别接受 Desarda（I 组）或 Lichtenstein（II 组）修复：85 例和 83 例。主要观察指标为腹股沟疝复发和慢性腹股沟疼痛。次要观察指标包括手术时间、术后疼痛评分、恢复正常步态和工作的时间、腹股沟异物感以及术后并发症。
在 2 年的随访中，两组各有 1 例复发（P = 0.99）。慢性腹股沟疼痛分别在 5.6%和 4.2%的 Desarda 和 Lichtenstein 组患者中发生（P = 0.68）。两组患者在五个时间点的术后 VAS 疼痛评分平均值上无显著统计学差异。Desarda 修复术组的手术时间更短，恢复正常步态的时间更早。两组患者的异物感无差异。
在不植入网片的情况下，使用 Desarda 修复术可以成功治疗腹股沟疝，其疗效与标准的 Lichtenstein 手术相当。手术时间更短、早期恢复正常步态和更低的成本（无需网片）是 Desarda 修复术的潜在优势。对于术中发现腹外斜肌腱膜薄弱、分裂或变薄的患者，需要进一步评估 Desarda 修复术的适用性。
