"No mesh inguinal hernia surgery-Desarda Repair"

Inguinal hernia repair without mesh or no mesh hernia surgery

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1ST WORLD HERNIA CONFERENCE HONOURED DR. MOHAN DESARDA BY INVITING HIM AS GUEST SPEAKER

Posted on May 21, 2015 at 12:15 AM Comments comments (0)

The first world hernia conference was held from 25 to 29 April 2015 at Milan city in Italy. Nearly 5000 surgeons from different countries all over the world attended this conference. Dr. Mohan Desarda received an honour by receiving an invitation from such a prestigious and magnificent conference as an invited faculty and guest speaker. This conference was held specially to discuss issues related with a very common disease ‘abdominal wall hernias’.

Every conference invites international faculties who are expert in that disease subject and have done some innovative work. They demonstrate their work to surgeons from all over the world so that they can carry this knowledge to their country for the benefit of society at large.

Dr. Mohan Desarda a Pune based senior surgeon and hernia expert has done basic invention in the hernia disease. The world conference took a notice of this and invited him as a guest speaker is an honour not only to him but to our nation. He challenged the old concepts that cough or weight lifting causes hernia and established that hernia occurs only because of a defect in the muscle. He also developed a new operation technique of muscle transfer to close this defect now practiced worldwide as ‘Desarda Technique’. This technique is now included in the medical text books of international repute. This is also an honour received by Dr. Desarda and all of us as Indians.

In traditional operations done today, surgeons stitch a mesh by open or laparoscopic surgery. Mesh being a foreign body has many inherent disadvantages and complications. Desarda repair does not use mesh or endoscopes so it does not have any complications associated with them. This operation is very simple to do and to understand for any surgeon. Dr. Desarda purposefully did not make any patent of this so that any surgeon can use this freely for the benefit of their patients. Patient can bend, squat, climb up the staircase, carry luggage and travel or go to office within couple of days after surgery without any fear of recurrence.

Dr. Desarda calls all surgeons to use this technique for repair of inguinal hernias in their patient and give them benefit of a mesh free surgery. Interested patients or doctors can contact on 7738181022 or email at Desarda@gmail.com or visit our website: www.desarda.com for more information.

Prof. Dr. Desarda M. P.

MS; FICS(USA); FICA(USA)

1] Chief of Hernia Center, Poona Hospital & Research Center

2] Professor Emeritus, Galaxy Care group of Hospitals

Mobile: 0091 7738181022 or 0091 9373322178

Email: desarda@gmail.com

Website: www.desarda.com

 

NEW TECHNIQUE OF HERNIA OPERATION GOES FROM INDIA TO GERMANY

Posted on February 6, 2013 at 12:20 AM Comments comments (0)

Dr. Mohan Desarda, an eminent hernia surgeon from Pune, is invited to Germany to deliver lecture and to demonstrate his invented new groin hernia operation technique in the international conference. “BERLIN HERNIA DAY” is a prestigious hernia conference organized in Berlin, the capital city of Germany. More than 500 surgeons from Europe, UK and USA take part in this conference to listen to speakers and learn more advanced operation techniques. Dr. Desarda is invited as Faculty teacher and speaker for this conference to be held on 25-26 January 2013 in Berlin.


The big problem in today’s hernia operation is that it recurs in spite of surgery again and again. It is great mental torture to face the failures of operation to the patients as well as family members. Almost all groin hernia operations are done to day where a mesh is stitched on the defect through open or laparoscopic surgery. This mesh is not safe in all respects to the body because this mesh is a simple piece of cloth prepared from the synthetic threads like Polypropylene or Polyester. Naturally, patients have to face all possible complications arising from stitching such foreign body inside the abdomen during surgery. Recurrence, pain, infection, migration, perforation, rejection, testicular ischemia are all known complications arising out of this mesh with which patient might have to suffer lifelong also. Strong nearby muscles become weak, atrophic and thin like paper causing permanent damage because mesh gets adherent to all nearby muscles and life of some patients even get ruined facing all these complications. It is very difficult and complicated to re-operate on such patients and still no guarantee of cure. In spite of this, some doctors advertise to operate with costly or 3D mesh etc. to attract patients for personal gains. Mesh and endoscope manufacturing companies also market use of mesh through doctors to increase their sails and earn more profits.

Because of this, research is going on for decades all over the world about inguinal hernias. Dr. Desarda did original research in this hernia disease and found the reason why groin hernia takes place and challenged all century old theories published in the text books by previous researchers. He also developed a new operation technique based on these new theories. It does not use any mesh during surgery, instead a strong and live strip of a nearby muscle is stitched on the hernia defect. Therefore, it gives complete cure from hernia with fast recovery. Patient can start his normal activities within couple of days without any fear of recurrence. Patients need hospitalization only for one day.

Inguinal hernia cannot be cured without surgery. Do not believe if somebody says to heal hernia with medicines or exercises or hernia belt or yoga. There is no pain in this disease so some patients neglect it and postpone surgery resulting into increase in size of hernia and its complications. So get hernia operated as early as possible from a good surgeon, Dr. Desarda advised.

 

?What is inguinal hernia & its new operation technique-Desarda Repair??

Posted on December 9, 2012 at 1:55 AM Comments comments (0)

Hernia disease is now generally known to common people just as appendicitis is known. When a bulge or swelling appears in the groin, every body knows that it is hernia. So bulge or swelling due to any other disease might be mistaken as hernia bulge. Like wise, hernia occurs only in the groin is also a misconception. It can occur any where inside the body as well as visibly out side the body. The hernias which are visible on the surface of the body mainly occur on the abdomen.

When any organ of our body or part of it leaves its original place and enters into other cavity through a defect or hole, it forms a hernia sac. This sac becomes visible on the abdomen when intestines enter in to it on coughing. This bulge seen on the abdomen is called as hernia. It is seen in nearly 1-1.5% of our people but this incidence is higher (2-3%) in the western countries and Africa. Abdominal wall hernias are given different names depending on the area where they arise. Inguinal hernia, umbilical hernia, epigastric hernia, lumbar hernia, spigelion hernia etc. are some of such hernias that are seen on the abdominal wall. Hernias can occur inside the body also that are not visible outside. Diaphragmatic hernia is an example of this.

Why hernia forms? Every body naturally wants to know as to why at all hernia forms in their body or on abdomen. What are the reasons? Weakness of the abdominal wall muscle cover at some place or spot is the main reason. Then if by any reason say like coughing or straining while passing stools or urine, intra-abdominal pressure rises and the result is the hernia formation through the weak spot. Chronic cough as seen in asthmatic patients, job of lifting heavy weights, constipation, obstruction in passing urine due to enlarged prostate are some of the important reasons that precipitates the hernia formation in the groin or at some other place on abdomen. Stretching of muscles as seen in pregnancy or ascitis can also result in hernia formation. These reasons are not seen in children; still they are affected with hernia due to pre formed hernia sac.


What are the symptoms: A soft swelling appearing in the groin that increases in size after coughing and disappears after lying down or during sleep then you can think that it is groin hernia. This groin swelling is small betel nut size in the beginning but later if kept untreated goes on increasing and enters in the scrotum also. Initially, this bulge can be pushed inside the abdomen but later it becomes impossible to push them back because intestines get adherent to the hernia sac. There is no pain in this hernia swelling. That is the main reason why people are not serious about its early treatment. In general, pain in hernia is to be understood as an alarming symptom. It occurs whenever this hernia gets obstructed and you can not push intestines back or when hernia gets strangulated, a serious condition. Blood supply to the intestines gets cut off and they start dying inside the hernia sac during the process of strangulation. Patient does not allow touching the hernia swelling because it becomes painful and tender. Some times, intestines get perforated inside the sac and peritonitis takes place. Patient starts vomiting, there is abdominal distension and general condition of the patient deteriorates fast. This is a life threatening emergency and needs to be operated immediately to save the life of the patient. Therefore, it is advised that hernia should be treated as early as possible and not to wait till it starts paining.

Examination & treatment: Examination of hernia gives an idea about the type of hernia and whether there are any complications developed in it. What type of organ e.g. intestines or omentum has entered the hernia sac is also judged. Then general examination is done to find out whether patient is having any systemic disease like bronchitis, hypertension, heart disease, enlarged prostate etc. Some blood tests, x-ray chest or ECG. is done to find out whether patient is fit to undergo surgery. If there are some serious complications developed in hernia and patient needs urgent surgery to save his life then patient can be taken for surgery without doing these tests also. Just as a torn shirt needs stitching to repair it, similarly this torn shirt of abdominal muscles also need proper stitching to repair the hernia. First of all the hernia sac is separated from other tissues and it is excised. Second part of the operation is to stitch the hernia hole to prevent hernia formation again. This is called as herniorrhaphy or hernioplasty. Therefore, do not believe if some body assures you that hernia can be cured without surgery and with medicines or some other means. Many times patients are advised to do exercises so as to strengthen the muscles and cure the hernia. It is absolutely wrong to do exercises when there is hernia because every exercise increases the intra-abdominal pressure and that tends to increase the size of hernia. Some times advice of using a hernia truss is given to avoid the surgery. This hernia truss or hernia belt is fitted on the hernia hole in an attempt to prevent it from coming outside. This is not cure to the hernia. At the most you can postpone surgery for some time by using it. But now surgeons clearly advise not to use truss in any situation because of its complications. Hernia belt slips from the hernia hole due to movements and the intestines can get obstructed easily giving rise to a dangerous situation of obstruction or strangulation.

Hernia operation is done by stitching a piece of synthetic cloth called as mesh on the hernia hole. Polypropylene, polyethylene, prolene, Dacron, Teflon is such synthetic chemical thread from which mesh is prepared. This mesh is imported and costly also. Therefore, at many places a low quality mesh is used to save on the cost. This increases the chances of hernia reappearing or getting infected. Recurrence, infection, pain, mesh migration are some of the well documented complications associated with this mesh repair because mesh is a synthetic cloth and a foreign body. Re-operation is the only remedy to treat those complications and this re-surgery is very difficult, complicated and commanding even in the hands of expert surgeons because mesh causes extensive damage to the nearby tissues and fibrosis. Techniques older than this are now discarded because they all had unacceptable rate of surgery failures.

A new technique- “Dr. Desarda repair”: A search to find out some operation technique that does not use mesh and gives excellent results was going on through out the world. Desarda repair introduced in the market in year 2001 became immediately popular because it gives what you want and that too without use of any foreign body like mesh. 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 goes home 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 rapidly around the globe and today it is being followed in many countries.

 

Interested patients and doctors can contact Dr. Desarda on his mobile no. 0091 (0)9373322178 or log on to his website  http/www.desarda.com OR EMAIL: desarda@hotmail.com

 

 

?Why hernia re-occurs again and again?

Posted on December 9, 2012 at 1:50 AM Comments comments (0)

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.

                       

                  Mesh shrinkage after surgery                            Mesh sutured on hernia hole does not give prtection

  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. 0091 (0)9373322178 or log on to his website http://www.desarda.com OR EMAIL: desarda@hotmail.com

?What is mesh used in hernia surgery??

Posted on December 9, 2012 at 1:50 AM Comments comments (0)

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.

 

    

Mesh Mesh stitched on hernia hole

 Mesh does not give protection

 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.

 

Shrinkage of mesh from palm to finger size

 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. 0091 (0)9373322178 or log on to his website http/www.desarda.com OR EMAIL: desarda@hotmail.com

 

"Complete cure from groin hernia is now possible with Dr.Desarda's repair technique......."

Posted on April 20, 2010 at 1:00 PM Comments comments (0)

             Mesh is a foreign body, a simple piece of cloth prepared from the synthetic threads. Therefore, its use in inguinal 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 homein 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 toTopix 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 moredetails: http://www.desarda.com    Our cell number: +91 9373322178

 


"THEORIES OF GROIN HERNIAFORMATION"

Posted on April 20, 2010 at 1:00 PM Comments comments (0)

            

As far as groin hernias are concerned, Prof. Dr. Desarda has raised questions about the theories mentioned in the text books that prevent herniation. Obliquity of inguinal canal or shutter mechanism or high muscle arch or patent processus vaginalis, etc., are not the real factors that prevent hernia formation in the normal individuals. Chronic cough or job of weight lifting is also not real factor that cause hernia formation in the normal individuals. Because not every individual having bronchial asthma develop hernia nor every coolie on the railway platform develop hernia. It means these are not the real factors that cause hernia formation in the normal individuals. The real factor that prevents hernia formation in the normal individual is presence of aponeurotic extensions from the transversus abdominis aponeurotic arch in first place and strong musculo-aponeurotic structures around the inguinal canal in the second place. REF: Desarda MP. Surgical physiology of inguinal hernia repair. BMC Surgery 2003, 3:2 or visit website http://www.desarda.com email: desarda@hotmail.com

Current inguinal hernia operations are generally based on anatomical considerations. Failures of such operations are due to lack of consideration of physiological aspects. Many patients with inguinal hernia are cured as a result of current techniques of operation, though factors that are said to prevent hernia formation are not restored. Therefore, the surgical physiology of inguinal canal needs to be reconsidered.

The successful management of any problem depends on the understanding of its patho-physiology. In this context, some questions related to the physiology of the inguinal canal or factors that prevent herniation still exist. Lateral and cephalad displacement of the internal ring beneath the transversus abdominis muscle and approximation of the crura results in a shutter mechanism at the internal ring. When the arcuate fibers of the internal oblique and transversus abdominis muscle contract, they straighten out and move closer to the inguinal ligament (shutter mechanism at the inguinal canal). This opposite movement (upward & downward) of the same muscle needs proper explanation. The term "obliquity of the inguinal canal" is not a perfect description since the spermatic cord is lying throughout its course on the transversalis fascia. Repeated acts of crying, thereby increasing the intra-abdominal pressure do not increase the incidence of hernia in new born babies in spite of the almost absent "obliquity of the inguinal canal" or "shutter mechanism". Similarly, every individual with a high arch or a patent processus vaginalis does not develop hernia. Factors that are said to prevent herniation are not restored in the traditional techniques of inguinal hernia repair and yet 70–98% of patients are cured. Then what are the additional factors that play a role in the prevention of hernia after surgery? Please visit our website for more details: http://www.desarda.com    EMAIL: desarda@hotmail.com

 



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