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      Desarda Versus Lichtenstein Technique for Primary Inguinal Hernia Treatment: 3-Year Results of a Randomized Clinical Trial

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          Abstract

          Background

          The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda’s technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda (D) and mesh-based Lichtenstein (L) techniques.

          Methods

          A total of 208 male patients were randomly assigned to the D or L group (105 vs. 103, respectively). The primary outcomes measured were recurrence and chronic pain. Additionally, early and late complications, foreign body sensation, and return to everyday activity were examined in hospital and at 7, 30 days, and 6, 12, 24, and 36 months after surgery.

          Results

          During the follow-up, two recurrences were observed in each group ( p = 1.000). Chronic pain was experienced by 4.8 and 2.9% of patients from groups D and L, respectively ( p = 0.464). Foreign body sensation and return to activity were not different between the groups. There was significantly less seroma production in the D group ( p = 0.004).

          Conclusions

          The results of primary inguinal hernia repair with the Desarda and Lichtenstein techniques are comparable at the 3-year follow-up. The technique may potentially increase the number of tissue-based methods available for treating groin hernias.

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          Most cited references37

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          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.

          (1986)
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            International guidelines for prevention and management of post-operative chronic pain following inguinal hernia surgery.

            To provide uniform terminology and definition of post-herniorrhaphy groin chronic pain. To give guidelines to the scientific community concerning the prevention and the treatment of chronic groin and testicular pain. A group of nine experts in hernia surgery was created in 2007. The group set up six clinical questions and continued to work on the answers, according to evidence-based literature. In 2008, an International Consensus Conference was held in Rome with the working group, with an audience of 200 participants, with a view to reaching a consensus for each question. A consensus was reached regarding a definition of chronic groin pain. The recommendation was to identify and preserve all three inguinal nerves during open inguinal hernia repair to reduce the risk of chronic groin pain. Likewise, elective resection of a suspected injured nerve was recommended. There was no recommendation for a procedure on the resected nerve ending and no recommendation for using glue during hernia repair. Surgical treatment (including all three nerves) should be suggested for patients who do not respond to no-surgery pain-management treatment; it is advisable to wait at least 1 year from the previous herniorraphy. The consensus reached on some open questions in the field of post-herniorrhaphy chronic pain may help to better analyze and compare studies, avoid sending erroneous messages to the scientific community, and provide some guidelines for the prevention and treatment of post-herniorraphy chronic pain.
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              • Record: found
              • Abstract: not found
              • Article: not found

              Chronic postoperative pain: the case of inguinal herniorrhaphy.

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                Author and article information

                Contributors
                jacek.szopinski@wp.pl
                Journal
                World J Surg
                World J Surg
                World Journal of Surgery
                Springer-Verlag (New York )
                0364-2313
                1432-2323
                3 March 2012
                3 March 2012
                May 2012
                : 36
                : 5
                : 984-992
                Affiliations
                [1 ]Department of General and Endocrine Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, ul. M. Sklodowskiej-Curie 9, 85-094 Bydgoszcz, Poland
                [2 ]Department of General, Gastrointestinal, and Cancer Surgery, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University of Torun, ul. Sw. Jozefa 53/59, 87-100 Torun, Poland
                [3 ]Department of General Surgery, Jonscher Community Hospital, ul. Milionowa 14, 93-113 Lodz, Poland
                Article
                1508
                10.1007/s00268-012-1508-1
                3321139
                22392354
                7531b092-78d8-4e58-98ef-d45509e84fc9
                © The Author(s) 2012
                History
                Categories
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                Custom metadata
                © Société Internationale de Chirurgie 2012

                Surgery
                Surgery

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