1. “Dr. Desarda’s Repair”
For
Inguinal Hernia
New Millennium Gift
BASED ON THE NEW CONCEPTS OF PHYSIOLOGY OF ING. CANAL THAT PREVENT HERNIA FORMATION

2. PROF. Dr. Desarda M. P. M. S. (GEN. SURG
PROF. Dr. Desarda M. P. M.S.(GEN.SURG.);FICS(USA);FICA(USA)
1. PROF.EMERITUS - GALAXY CARE GROUP OF HOSPITALS, PUNE
2. CHIEF, HERNIA CENTRE, POONA HOSPITAL & RESEARCH CENTRE
3. PROFESSOR & CONS. GENERAL SURGEON- POONA HOSPITAL & RESEARCH CENTRE, PUNE
4. EX-PROFESSOR OF SURGERY
KAMALA NEHRU GENERAL HOSPITAL
5. EX-ASSO. PROFESSOR OF SURGERY BHARATI VIDYAPITH MED. COLLEGE

3. TODAYS TRENDS IN GRPOIN
HERNIA SURGERY
DO WE NEED TO CHANGE IT?
IN CONTEXT WITH
WHEN & WHY
“DESARDA REPAIR”

4. MY ANSWER IS
“Always use this repair BECAUSE it gives complete cure without any foreign body”
It is tension free, recurrence free and with the lowest rate of complications.
You repair hernia with continuous abs. sutures, a thing never imagined till today.
It is a very simple physiological repair, easy to learn & follow and can be done on out door basis under L.A. and with fast recovery.
This repair is now followed by many surgeons in many countries. Wikipedia described it in a separate section as “Tension free pure tissue repair”

5. WHAT ABOUT MESH REPAIR
Q1: Mesh is a simple piece of synthetic cloth prepared from Polypropylene or Polyester. Would you accept its routine use in all the cases? IDEALLY NOT !!!!
You are extremely cautious not to forget a swab in side body during any surgery
Q2: Then how you are stitching a swab like piece of cloth in side the body in mesh repairs leaving patient to his own fate !! What we are doing today is right ?

6. WHY NOT MESH REPAIR ? Mesh is a foreign body, is known to every one
Millions of micro abscesses are formed & dense fibrous tissue is laid down in inguinal canal is also known to every one.
1] That distorts anatomy 2] Atrophies muscles 3] Nerves, vas & vessels get engulfed and affected 4] There are complications like pain, infection, testicular atrophy, sinus formation, recurrence and many more.
These all complications are also known to every one & still mesh is routinely used in all ing. hernia repairs. WHY?

7. WHY NOT LAPAROSCOPIC REPAIR ?
All complications of mesh are present in laparoscopic repairs also. In fact, these complications carry high risk because mesh is stitched in side the abdomen (preperitonial).
Additional complications are internal oozing, risk of general anesthesia & abd. inflation with gas, nerve damage, trauma to viscera, trocar hernia, recurrences and many more.
You can imagine what would happen to vas & testicular vessels due to mesh fibrosis because mesh is directly spread on these vas & vessels.

9. Thus you know that mesh is not 100% safe to body for its routine use in all the cases
Lap. repair carry higher risk & requires extreme skills to give excellent results.
Many patients life world wide might be getting affected by unscrupulous use of endoscopes by inadequately trained surgeons.
Imagine the fate of millions of patients operated in remote places by many surgeons with low quality mesh without any standards.
Pharma companies will not bother for patients BUT you must bother for your patients.

10. Surgical fraternity thrives for 100% safety & cure & no major complications in every surgery.
Then how we have accepted mesh repairs in spite of its morbidity & complications? & continue to use open or Lap. mesh repairs ?
This is all done by strong financial giants of mesh & endoscope mfg. companies by perfect marketing at all levels & by all means.
Product costing less than 1 Euro is being sold at Euro making huge profits. Any company will market this product by all means:- May be ETHICAL or UNETHICAL

11. Lies, Damned Lies, and Medical Science
Much of what medical researchers conclude in their studies is misleading, exaggerated, or wrong. So why doctors are carrying this misinformation in their everyday practice? Dr. John was interviewed by David H. Freedman

12. BILL MOYER INTERVIEWS MELODY PETERSON ON CNN TV

13. In her newest book, Our daily meds
She describes drug makers as an industry whose core drive is profit.
Melody says-I actually thought that there is a lot of science. That's what they tell the public. But as I started to follow their daily activities and talk to executives, I learned that really it was marketing that drove them to earn more profits without bothering much for patients safety!!!

14. With their hoards of cash, the companies have readily handed money to patient groups, hospitals, universities, medical schools, physician societies, government agencies, and just about any organization they want on their side. [...]
The industry's cash-filled coffers have a strong hold on medical science.
SIMILAR IS THE STORY SEEN WITH MESH & ENDOSCOPE MANUFACTURING COMPANIES

15. WHAT IS THEIR MARKETING MAGIC?
Control publishing houses and publish repeatedly similar articles through various doctors claiming mesh repair is the best.
Control conferences & make leading doctors to present how mesh repair is the best.
Start CME in conferences & make it compulsory to attend to post-graduate students & then hammer on to their mind same thing again how mesh repair is the best.
Come out with new products of mesh & again send leading doctors to various seminars to show how mesh repair is the best.

16. Stop thinking beyond mesh for hernia repairs.
Advantage of faith posed by trainee doctors and students in their teachers is exploited. Repeated presentations are made in conferences, repeated publications are made in magazines & the song about mesh goes on & on till junior and budding surgeons mind gets preconditioned to such an extent that they…………
Stop thinking beyond mesh for hernia repairs.

17. WHO IS THE LOOSER
The deadliest looser is your own patient. Many patients operated with mesh, open or laparoscopic repair suffer from morbidity & complications. Some patients life gets ruined. Who is responsible for this?
But still companies with our help are busy in marketing their product like a soap or hair shampoo, every time coming out with a new variant of the same synthetic cloth like mesh, then mesh & plug, then PHS, then heavy weight, then light weight, then small pores, then large pores etc. etc.

18. WHO IS THE WINNER
And the winner is mesh manufacturing company that silently pocket millions of $ profit every year from all over the world.
And what about doctors who are catalytic agents and with whose help companies are making huge profits get? NOTHING or a tour abroad or in India-that’s it. It is my guess.
Our prestigious organizations have all given our platform to them and made them financially giant. But still, we doctors have to bargain with them about selling stalls or getting advertisements or sponsorships.

19. Let us all stop this immediately.
Let us act today itself and the first step towards this will be to listen to what my research is about the new theories of hernia formation and my new operation technique AND
TO ACHIVE THIS LET US UNDERSTAND THE AETIO-PATHOLOGY OF INGUINAL CANAL
“We claim that old concepts that prevent inguinal hernia formation described in the text books are not at all true”

20. 1] Strength of Transversalis fascia described in every text book is not true. The Trans. Fascia do not have any strength & it can not give any protection because it is paper thin. It is just an extension of the endo-abdominal fascia.
2] Obliquity of the inguinal canal: is not true because the spermatic cord is
lying throughout its course on
the trans. fascia alone. It does
not pierce any muscle as stated
in all the text books.
3] Every individual with high arch or a patent processus vaginalis do not develop hernia.

21. 4] Shutter mechanism: is also not true because repeated acts of crying does not increase the incidence of hernia in new born babies in spite of the almost absent "obliquity of inguinal canal" or "shutter mechanism”
Shutter mechanism at int. ring: says
Medial border of int. ring is pulled
upwards & laterally to close the int.
ring & Shutter mechanism at canal:
says that oblique fibers of the
muscle arch moves down & medially to go close to the inguinal ligament. This opposite movement of the same muscle can not be accepted

22. So, these are not the real factors that prevent hernia formation
5] Those concepts that are said to prevent herniation are not at all restored in the traditional techniques of inguinal hernia repair and yet 70–98% of pts. are cured.
So, these are not the real factors that prevent hernia formation
Then what are the real factors that prevent hernia formation?
“Aponeurotic Extensions from the Transversus Abdominis Aponeurotic Arch in the posterior wall is the real factor that prevents hernia formation in the normal individuals.”

23. ANATOMY OF ING.CANAL -post. view

24. NORMAL FULL COVER OF APO. EXT.

25. Scanty Aponeurotic Extensions seen

27. POSTERIOR WALL
This posterior wall is not composed of ONE layer of trans. fascia as is described in all the text books but is composed of TWO layers. 1] Trans. fascia & 2] Aponeurotic Extensions
The strength of the posterior wall is directly related to the number of Aponeurotic fibers it contains & not to the strength of the Trans. Fascia.
The Aponeurotic extensions give mechanical strength to the posterior wall to resist internal abdominal blows and prevent hernia formation

28. POSTERIOR WALL AT REST

29. DYNAMIC POSTERIOR WALL
This posterior wall is kept physiologically dynamic due to those Aponeurotic Extensions & muscle contractions.
Muscle contraction of the transversus abdominis pulls these Aponeurotic Extensions upward and laterally creating tension in it to prevent hernia formation (Physiologically dynamic action of the post. wall)

30. POSTERIOR WALL IN ACTION

31. DYNAMIC POSTERIOR WALL
This tension in the posterior wall is created in gradation as per the force of contraction of the muscles. And the force of contraction of the muscles changes as per the force of the internal abdominal blow. This is important physiological phenomenon. The posterior wall plays an important role in the prevention of hernia formation not only because of its mechanical strength but also because of its dynamic nature
“Such a physiologically dynamic & strong posterior wall is needed to be constructed to give 100% cure from the inguinal hernias”

32. My Operation
Technique
NO MESH OPEN INGUINAL HERNIA REPAIR WITH CONTINIOUS ABSORBABLE SUTURES BASED ON PHYSIOLOGICAL PRINCIPLE

40. Mechanism of action that prevents recurrence

41. Mechanism of action that prevents recurrence

42. STATUS TODAY
Today, this operation is being followed in many countries like Poland, USA, China, Mexico, Malaysia, Cuba, Ukraine, Albania, Libya, Brazil, Russia, Korea, & many other such countries.
More than 90 presentations or publications and half a dozen RCT are conducted on this repair. Results are similar to or superior to mesh repairs.
We have operated on more than 2000 patients till today showing fast recovery, early ambulation, less than 0.1% complications & no recurrence.
I hope that text books will soon take a note of our new theories & the operation technique.

43. WE ARE THE FIRST IN THE WORLD
We are the first to put before the world that ing. hernia must be repaired on physiological principle to give total cure
We are the first to scrap century old theories that prevent hernia formation and publish new theory
We are the first to give you a very simple hernia repair that does not use mesh
We are the first to use all absorbable sutures inside leaving no trace of foreign body after surgery
We are the first to give you complete cure after surgery without any fear of recurrence

44. NOW YOU DECIDE
Whether to continue with open or laparoscopic mesh repair or to shift to this mesh free “Desarda Repair”
MY ANSWER IS
“There is no place for mesh prostheses now in hernia repairs because no mesh technique of “Desarda Repair” is available with superior results.”

52. THANK YOU