“THEORIES OF GROIN HERNIA FORMATION”
Dr. Desarda’s theory – Transversalis fascia can not give and never gives protection from the herniation process as believed today or stated in the text books or various research articles. Transversalis fascia is papery thin and is an extension of the endo-abdominal fascia. Posterior wall of the inguinal canal is not only a single layer wall composed of the transversalis fascia as believed today but is composed of two layers. Transversalis fascia is a posterior layer and in front of it is another layer composed of the aponeurotic extensions from the Transversus Abdominis Aponeurotic Arch also called as the "Dessidious part of the Transversus Abdominis Aponeurotic Arch" These aponeurotic extensions in the posterior wall of the inguinal canal gives real protection from the herniation process. The inguinal hernia formation can take place only if these aponeurotic extensions are absent or deficient. Loss of strength and physiologically a-dynamic nature of the posterior wall of the inguinal canal due to absent aponeurotic extensions in the posterior wall and loss of strength of cremasteric fascia and musculo-aponeurotic structures around the inguinal canal are the real factors or the cause of hernia formation. Read our research article: Surgical physiology of inguinal hernia repair - a study of 200 cases Mohan P Desarda BMC Surgery 2003, 3:2 doi:10.1186/1471-2482-3-2 http://www.biomedcentral.com/1471-2482/3/2/
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 are also not real factors 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 aponurotic 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://herniasurgery.tripod.com or http://www.desarda.com
If these aponeurotic extensions are either absent or deficient in the posterior wall of the inguinal canal then only that individual will develop groin hernia. We replace in our operation technique these absent or deficient aponeurotic element by stitching in that place a strip of the external oblique muscle aponeurosis, a near by muscle. This is a live and dynamic muscle of your own body and hence there is fast recovery, minipal or no pain and no recurrence.
"ABSENT OR DEFICIENT APO. EXTENSIONS RESULT IN TO HERNIA FORMATION"
Mechanism of action:
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.
Inguinal hernia repair still remains a problem because of the 1) high recurrence rates seen in the hands of the junior surgeons, 2) risky dissection of the inguinal floor in the Bassini/Shouldice repair and 3) infection and chronic groin pain following mesh repair. 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).[2,3] 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 inspite 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?The author conducted this study in 200 patients who were operated by his technique under local anaesthesia, and observed the changes in the physiology of structures in and around the inguinal canal, before and after repair of the inguinal hernia. The author described for the first time, a new method of inguinal hernia repair based on physiological principles.