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Published in: Hernia 3/2018

01-06-2018 | Review

Desarda’s technique versus Lichtenstein technique for the treatment of primary inguinal hernia: a systematic review and meta-analysis of randomized controlled trials

Authors: S. H. Emile, H. Elfeki

Published in: Hernia | Issue 3/2018

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Abstract

Purpose

The Lichtenstein technique (LT) has been recognized as the standard treatment for inguinal hernia in adults owing to the high recurrence rates of tissue-based repairs. However, Desarda technique (DT) appeared as promising tissue-based repair that provided low incidence of recurrence without the need for implanting prosthetic or foreign materials in the inguinal canal. This meta-analysis of randomized controlled trials (RCTs) comparing DT and LT for primary inguinal hernia in adults aimed to determine which technique had better clinical outcome regarding recurrence and complication rates.

Methods

A systematic literature search for RCTs comparing between DT and LT was conducted using electronic databases and Google scholar service. Patients’ characteristics, technical details, recurrence and complication rates, and time to resume daily activities were extracted from the original studies and analyzed.

Results

Six RCTs comprising 2159 patients (89% males) were included. No significant difference in the incidence of recurrence between both techniques was detected (OR = 0.946; P = 0.91). The overall complication rate of LT was significantly higher than DT (OR = 1.86; P < 0.001). LT had significantly higher rates of seroma formation and surgical site infection (OR = 2.17; P = 0.007) and (OR = 2.17; P = 0.029), respectively. Postoperative pain, operation time, and time to resume normal activities were comparable in both groups.

Conclusion

Both DT and LT provided satisfactory treatment for primary inguinal hernia with low recurrence rates and acceptable rates of complications that were significantly less after DT. More well-designed RCTs with longer follow-up are required for further validation of the DT.
Literature
1.
go back to reference Awad SS, Fagan SP (2004) Current approaches to inguinal hernia repair. Am J Surg 188(6A Suppl):9S–16SCrossRefPubMed Awad SS, Fagan SP (2004) Current approaches to inguinal hernia repair. Am J Surg 188(6A Suppl):9S–16SCrossRefPubMed
2.
go back to reference Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–839CrossRefPubMed Primatesta P, Goldacre MJ (1996) Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol 25:835–839CrossRefPubMed
3.
go back to reference Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev (4):CD002197 Scott NW, McCormack K, Graham P, Go PM, Ross SJ, Grant AM (2002) Open mesh versus non-mesh for repair of femoral and inguinal hernia. Cochrane Database Syst Rev (4):CD002197
4.
go back to reference Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403CrossRefPubMedPubMedCentral Simons MP, Aufenacker T, Bay-Nielsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403CrossRefPubMedPubMedCentral
5.
go back to reference Lichtenstein IL, Shulman AG, Amid PK et al (1989) The tension free hernioplasty. Am J Surg 157:88–193CrossRef Lichtenstein IL, Shulman AG, Amid PK et al (1989) The tension free hernioplasty. Am J Surg 157:88–193CrossRef
6.
go back to reference Amid PK, Shulman AG, Lichtenstein IL (1996) Open ‘‘tension free’’ repair of inguinal hernias: the Lichtenstein technique. Eur J Surg 162:447–453PubMed Amid PK, Shulman AG, Lichtenstein IL (1996) Open ‘‘tension free’’ repair of inguinal hernias: the Lichtenstein technique. Eur J Surg 162:447–453PubMed
7.
8.
go back to reference D’Amore L, Gossetti F, Vermeil V et al (2008) Long-term discomfort after plug and patch hernioplasty. Hernia 12:445–446CrossRefPubMed D’Amore L, Gossetti F, Vermeil V et al (2008) Long-term discomfort after plug and patch hernioplasty. Hernia 12:445–446CrossRefPubMed
9.
go back to reference Hamy A, Paineau J, Savigny JL et al (1997) Sigmoid perforation, an exceptional late complication of peritoneal prosthesis for treatment of inguinal hernia. Int Surg 82:307–308PubMed Hamy A, Paineau J, Savigny JL et al (1997) Sigmoid perforation, an exceptional late complication of peritoneal prosthesis for treatment of inguinal hernia. Int Surg 82:307–308PubMed
12.
13.
go back to reference Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcareinterventions: explanation and elaboration. BMJ 21(339):b2700CrossRef Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, Clarke M, Devereaux PJ, Kleijnen J, Moher D (2009) The PRISMA statement for reporting systematic reviews and metaanalyses of studies that evaluate healthcareinterventions: explanation and elaboration. BMJ 21(339):b2700CrossRef
14.
go back to reference Manyilirah W, Kijjambu S, Upoki A, Kiryabwire J (2012) Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT. Hernia 16(2):133–144 Epub 2011 Oct 8 CrossRefPubMed Manyilirah W, Kijjambu S, Upoki A, Kiryabwire J (2012) Comparison of non-mesh (Desarda) and mesh (Lichtenstein) methods for inguinal hernia repair among black African patients: a short-term double-blind RCT. Hernia 16(2):133–144 Epub 2011 Oct 8 CrossRefPubMed
15.
go back to reference Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z (2012) Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg 36(5):984–992CrossRefPubMedPubMedCentral Szopinski J, Dabrowiecki S, Pierscinski S, Jackowski M, Jaworski M, Szuflet Z (2012) Desarda versus Lichtenstein technique for primary inguinal hernia treatment: 3-year results of a randomized clinical trial. World J Surg 36(5):984–992CrossRefPubMedPubMedCentral
16.
go back to reference Rodríguez P, Herrera P, Gonzalez O, Alonso J, Blanco H (2013) A randomized trial comparing lichtenstein repair and no mesh desarda repair for inguinal hernia: a study of 1382 patients. East Central Afr J Surg 18(2):18–25 Rodríguez P, Herrera P, Gonzalez O, Alonso J, Blanco H (2013) A randomized trial comparing lichtenstein repair and no mesh desarda repair for inguinal hernia: a study of 1382 patients. East Central Afr J Surg 18(2):18–25
17.
go back to reference Youssef T, El-Alfy K, Farid M (2015) Randomized clinical trial of Desarda versus Lichtenstein repair for treatment of primary inguinal hernia. Int J Surg 20:28–34CrossRefPubMed Youssef T, El-Alfy K, Farid M (2015) Randomized clinical trial of Desarda versus Lichtenstein repair for treatment of primary inguinal hernia. Int J Surg 20:28–34CrossRefPubMed
18.
go back to reference Bhatti I, Ishaqu H, Ahmad Z, Dar U (2015) Desarda’s versus lichtenstein technique of hernia repair. Pak J Med Health Sci 9(4):1331 Bhatti I, Ishaqu H, Ahmad Z, Dar U (2015) Desarda’s versus lichtenstein technique of hernia repair. Pak J Med Health Sci 9(4):1331
19.
go back to reference Ahmad I, Dwivedi AC, Srivastava SK, Singh HP, Singh AK (2016) randomized trial comparing Lichenstein and Desarda technique for open inguinal hernia repair—a study of 100 patient. J Dent Med Sci 15(3):17–20. doi:10.9790/0853-1503081720 CrossRef Ahmad I, Dwivedi AC, Srivastava SK, Singh HP, Singh AK (2016) randomized trial comparing Lichenstein and Desarda technique for open inguinal hernia repair—a study of 100 patient. J Dent Med Sci 15(3):17–20. doi:10.​9790/​0853-1503081720 CrossRef
20.
go back to reference Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 18(343):d5928CrossRef Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA, Cochrane Bias Methods Group, Cochrane Statistical Methods Group (2011) The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ 18(343):d5928CrossRef
21.
go back to reference Hay JM, Boudet MJ, Fingerhut A et al (1995) Shouldice inguinal hernia repair in the male adult: the gold standard? A multicentral controlled trial in 1578 patients. Ann Surg 222:719–727CrossRefPubMedPubMedCentral Hay JM, Boudet MJ, Fingerhut A et al (1995) Shouldice inguinal hernia repair in the male adult: the gold standard? A multicentral controlled trial in 1578 patients. Ann Surg 222:719–727CrossRefPubMedPubMedCentral
22.
23.
go back to reference Junge K, Rosch R, Klinge U et al (2006) Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia 10:309–315CrossRefPubMed Junge K, Rosch R, Klinge U et al (2006) Risk factors related to recurrence in inguinal hernia repair: a retrospective analysis. Hernia 10:309–315CrossRefPubMed
24.
go back to reference National Institute of Clinical Excellence(NICE) (2004) Final appraisal determination, laparoscopic surgery for inguinal hernia repair. London National Institute of Clinical Excellence(NICE) (2004) Final appraisal determination, laparoscopic surgery for inguinal hernia repair. London
25.
go back to reference Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7CrossRefPubMed Amid PK (2004) Lichtenstein tension-free hernioplasty: its inception, evolution, and principles. Hernia 8:1–7CrossRefPubMed
26.
go back to reference Kurzer M, Belsham PA, Kark AE (2003) The Lichtenstein repair for groin hernias. Surg Clin North Am 83:1099–1117CrossRefPubMed Kurzer M, Belsham PA, Kark AE (2003) The Lichtenstein repair for groin hernias. Surg Clin North Am 83:1099–1117CrossRefPubMed
27.
go back to reference Verstraete L, Becaus N, Swannet H, Ceelen W, Duchateau L, Speybroeck N (2015) Long term outcome after lichtenstein hernia repair using general, locoregional or local anaesthesia. Acta Chir Belg 115(2):136–141CrossRefPubMed Verstraete L, Becaus N, Swannet H, Ceelen W, Duchateau L, Speybroeck N (2015) Long term outcome after lichtenstein hernia repair using general, locoregional or local anaesthesia. Acta Chir Belg 115(2):136–141CrossRefPubMed
28.
go back to reference Zieren J, Beyersdorff D, Beier KM et al (2001) Sexual function and testicular perfusion after inguinal hernia repair with mesh. Am J Surg 181(3):204–206CrossRefPubMed Zieren J, Beyersdorff D, Beier KM et al (2001) Sexual function and testicular perfusion after inguinal hernia repair with mesh. Am J Surg 181(3):204–206CrossRefPubMed
29.
30.
go back to reference Earle DB, Mark LA (2008) Prosthetic material in inguinal hernia repair: how do I choose? Surg Clin North Am 88(1):179–201CrossRefPubMed Earle DB, Mark LA (2008) Prosthetic material in inguinal hernia repair: how do I choose? Surg Clin North Am 88(1):179–201CrossRefPubMed
31.
go back to reference Losanoff JE, Millis JM (2006) Aponeurosis instead of prosthetic mesh for inguinal hernia repair: neither physiological nor new. Hernia 10(2):1981–1999 Losanoff JE, Millis JM (2006) Aponeurosis instead of prosthetic mesh for inguinal hernia repair: neither physiological nor new. Hernia 10(2):1981–1999
33.
go back to reference Desarda MP (2006) Physiological repair of inguinal hernia: a new technique (study of 860 patients). Hernia 10(2):143–146 Epub 2005 Dec 9 CrossRefPubMed Desarda MP (2006) Physiological repair of inguinal hernia: a new technique (study of 860 patients). Hernia 10(2):143–146 Epub 2005 Dec 9 CrossRefPubMed
34.
go back to reference Desarda MP, Ghosh DN (2006) Comparative study of open mesh repair and Desarda’s nomesh repair in a district hospital in India. East Central Afr J Surg 11(2):18–34 Desarda MP, Ghosh DN (2006) Comparative study of open mesh repair and Desarda’s nomesh repair in a district hospital in India. East Central Afr J Surg 11(2):18–34
35.
go back to reference Mitura K, Romańczuk M (2008) Comparison between two methods of inguinal hernia surgery–Lichtenstein and Desarda. Pol Merkur Lekarski 24(143):392–395PubMed Mitura K, Romańczuk M (2008) Comparison between two methods of inguinal hernia surgery–Lichtenstein and Desarda. Pol Merkur Lekarski 24(143):392–395PubMed
36.
go back to reference Klinge U, Zheng H, Si ZY et al (1999) Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases1 and 13 in hernia sac of patients with inguinal hernia. Int J Surg Investig 1:219–227PubMed Klinge U, Zheng H, Si ZY et al (1999) Synthesis of type I and III collagen, expression of fibronectin and matrix metalloproteinases1 and 13 in hernia sac of patients with inguinal hernia. Int J Surg Investig 1:219–227PubMed
37.
go back to reference Zheng H, Si Z, Kasperk R et al (2002) Recurrent inguinal hernia: disease of the collagen matrix? World J Surg 26:401–408CrossRefPubMed Zheng H, Si Z, Kasperk R et al (2002) Recurrent inguinal hernia: disease of the collagen matrix? World J Surg 26:401–408CrossRefPubMed
38.
go back to reference Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am 73(3):413–426CrossRefPubMed Rutkow IM, Robbins AW (1993) Demographic, classificatory, and socioeconomic aspects of hernia repair in the United States. Surg Clin North Am 73(3):413–426CrossRefPubMed
39.
go back to reference Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, King PM, O’Dwyer PJ (2004) Surgical site infection after groin hernia repair. Br J Surg 91(1):105–111CrossRefPubMed Taylor EW, Duffy K, Lee K, Hill R, Noone A, Macintyre I, King PM, O’Dwyer PJ (2004) Surgical site infection after groin hernia repair. Br J Surg 91(1):105–111CrossRefPubMed
40.
go back to reference (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 3:S1-226 (1986) Classification of chronic pain. Descriptions of chronic pain syndromes and definitions of pain terms. Prepared by the International Association for the Study of Pain, Subcommittee on Taxonomy. Pain Suppl 3:S1-226
41.
go back to reference Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of postoperative chronic pain following inguinal hernia surgery. Hernia 15:239–249CrossRefPubMed Alfieri S, Amid PK, Campanelli G et al (2011) International guidelines for prevention and management of postoperative chronic pain following inguinal hernia surgery. Hernia 15:239–249CrossRefPubMed
42.
go back to reference BayNielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7CrossRef BayNielsen M, Perkins FM, Kehlet H (2001) Pain and functional impairment 1 year after inguinal herniorrhaphy: a nationwide questionnaire study. Ann Surg 233:1–7CrossRef
43.
go back to reference de Goede B, Klitsie PJ, van Kempen BJ, Timmermans L, Jeekel J, Kazemier G, Lange JF (2013) Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair. Br J Surg 100(6):735–742. doi:10.1002/bjs.9072 CrossRefPubMed de Goede B, Klitsie PJ, van Kempen BJ, Timmermans L, Jeekel J, Kazemier G, Lange JF (2013) Meta-analysis of glue versus sutured mesh fixation for Lichtenstein inguinal hernia repair. Br J Surg 100(6):735–742. doi:10.​1002/​bjs.​9072 CrossRefPubMed
44.
go back to reference McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203CrossRefPubMed McCormack K, Wake B, Perez J, Fraser C, Cook J, McIntosh E, Vale L, Grant A (2005) Laparoscopic surgery for inguinal hernia repair: systematic review of effectiveness and economic evaluation. Health Technol Assess 9(14):1–203CrossRefPubMed
45.
go back to reference Löfgren J, Nordin P, Ibingira C, Matovu A, Galiwango E, Wladis A (2016) A randomized trial of low-cost mesh in groin hernia repair. N Engl J Med 374(2):146–153CrossRefPubMed Löfgren J, Nordin P, Ibingira C, Matovu A, Galiwango E, Wladis A (2016) A randomized trial of low-cost mesh in groin hernia repair. N Engl J Med 374(2):146–153CrossRefPubMed
46.
go back to reference Jones P, Jones S, Guarnieri F, Moscatelli F, Smaldone W, Nwamba C, Desarda M (2015) Inguinal hernia—mesh vs non mesh. Hernia 19(Suppl 1):S265–S266CrossRefPubMed Jones P, Jones S, Guarnieri F, Moscatelli F, Smaldone W, Nwamba C, Desarda M (2015) Inguinal hernia—mesh vs non mesh. Hernia 19(Suppl 1):S265–S266CrossRefPubMed
Metadata
Title
Desarda’s technique versus Lichtenstein technique for the treatment of primary inguinal hernia: a systematic review and meta-analysis of randomized controlled trials
Authors
S. H. Emile
H. Elfeki
Publication date
01-06-2018
Publisher
Springer Paris
Published in
Hernia / Issue 3/2018
Print ISSN: 1265-4906
Electronic ISSN: 1248-9204
DOI
https://doi.org/10.1007/s10029-017-1666-z

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