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BASED ON THE NEW CONCEPTS OF PHYSIOLOGY OF ING. CANAL THAT PREVENT HERNIA FORMATION.

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Prezentacja na temat: "BASED ON THE NEW CONCEPTS OF PHYSIOLOGY OF ING. CANAL THAT PREVENT HERNIA FORMATION."— Zapis prezentacji:

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2 BASED ON THE NEW CONCEPTS OF PHYSIOLOGY OF ING. CANAL THAT PREVENT HERNIA FORMATION

3 PROF. Dr. Desarda M. P. M.S.(GEN.SURG.);FICS(USA);FICA(USA) HERNIALOGIST & GENERAL SURGEON 1. IN CHARGE, HERNIA CENTRE, POONA HOSPITAL & RESEARCH CENTRE 2. PROF. & HEAD OF DEPT OF SURGERY POONA HOSPITAL & RESEARCH CENTRE 3. EX-PROFESSOR OF SURGERY AT KAMALA NEHRU GENERAL HOSPITAL 4. EX-ASSO. PROFESSOR OF SURGERY AT BHARATI VIDYAPITH MED. COLLEGE

4 Hernia Hernia is protrusion of a viscus or part of viscus from one cavity to other cavity

5 Classification HERNIA Congenital Acquired Internal Dorsal External Ventral Inguinal Epigastric Umbilical Paraumb. Spigelian Incisional

6 Inguinal Hernia Congenital Acquired Direct Indirect Mixed Reducible Irreducible Obstructed Strangulated Inflamed

7 Incidence 1) 1) 2-5% of population suffer from Hernia 70 to 75% Inguinal Hernias 15 to 18% femoral Hernias 7 to 9% umbilical Hernias 1 to 2% other types 2) 2) 10% of all operations are Hernia operations 70% Inguinal Hernia operations 30% other Hernia operations

8 Aetiology 1 1 Patent processus vaginalis 2 2 Raised intra abd. pressure 1 1 Patent processus vaginalis 2 2 Raised intra abd. pressure Chr. Coug h Chr. Coug h Constipation Strainin g Mict. Strainin g Mict. Weight lifting Weight lifting Ascites Othe r 3 Stretching of abd. muscles Obesity Pregnancy Ascites Other 4 No obvious cause

9 Physiology of Inguinal Canal Obliquity of ing. canal Shutter mechanism at int. ring Shutter mechanism at ing. canal Strength of transversalis fascia Patho-Physiology in Hernia Shutter mechanism is lost & trans.fasc.is weakened High position of trans. apo. Arch Reduced collagen content -- due to Reduced collagen synthesis 50% reduction in fibro. proliferation

10 Diagnosis Complaints å å Inguinal swelling å å Vague discomfort å å Pain Clinical exam å å Ing. bulge å å Cough on impulse å å Finger invagination test å å Internal ring occlusion test Complaints å å Inguinal swelling å å Vague discomfort å å Pain Clinical exam å å Ing. bulge å å Cough on impulse å å Finger invagination test å å Internal ring occlusion test Standing Lying Standing Lying

11 Differential Diagnosis 1) 1) Inguinal lymphadenopathy 2) 2) Femoral Hernia 3) 3) Hydrocoele of cord 4) 4) Lipoma of cord 5) 5) Ectopic testes 6) 6) Femoral adenitis 7) 7) Saphenous varix 1) 1) Inguinal lymphadenopathy 2) 2) Femoral Hernia 3) 3) Hydrocoele of cord 4) 4) Lipoma of cord 5) 5) Ectopic testes 6) 6) Femoral adenitis 7) 7) Saphenous varix

12 Why Treat Hernia ? Enlargement in size of hernia Incarcenation Obstructed situation strangulation Intestinal obstruction Peritonitis Urgent surgical intervention is the only treatment 1 out of 10 causes of death is intestinal obstruction due to Hernias

13 Journey Hippocrates (400 BC) - first described hernia Celsus (1st cent. AD) - first to advise surgery Gimbenat, Hasselbach, cooper ( ) careful dissection of ing. canal Lucas championniere (1881) first opened ing. canal for surgery Marcy (1881) - first to describe logical step in reconstructive repair Bassini ( ) - first to provide strong posterior wall

14 Bassini’s Repair Dissection & excision of ing. floor Tightening of int. ring Suturing int. obl & trans. abd muscles to ing. ligament This operation became popular BUT “ Revaluation by many other surgeons revealed very high & unacceptable recurrence rate ” Dissection & excision of ing. floor Tightening of int. ring Suturing int. obl & trans. abd muscles to ing. ligament This operation became popular BUT “ Revaluation by many other surgeons revealed very high & unacceptable recurrence rate ”

15 Failure Data (Indirect hernia) SurgeonNumber Recurrence Falli’s % John Hopkins % Max pageLondon police 20.2% Selinger % Goldner % Coley %

16 Failure Data (Direct hernia) SurgeonNumber Recurrence Falli’s % John Hopkins % Lamberts % Taylor % Max PageLondon Police 25.8%

17 Journey (Contd…) High recurrence rate of Bassini’s repair prompted introduction of many other modifications Halsted Blood good McVay Darning Operation Tantalum Gauge or Dacron net Hernioplasty But none of those are accepted for equally high failure rates or some other reason. kAndrews kZimmerman kTanner

18 Journey (20th Century) Accepted methods of repair today Shouldice (1945) - since 5 decades Lichtenstein Mesh - since 1 decade Laparoscopic repair -since 1 decade Bassini’s repair - since one century

19 Shouldice Repair Excision of weak ing. floor Excision of cribriform fascia Cremaster muscle sling 4 layer suturing with stainless steel wire Genital nerve, ext.spermatic vessels, & cremasteric muscle salvaged Danger to iliopubic vein & femoral vessels  troublesome bleeding

20 Lichtenstein Mesh Repair No dissection of ing. floor 8cm x 16cm mesh sutured behind the cord Simple & safe BUT 8 8 Disadvantages of foreign body 8 8 Mesh not available every where 8 8 Cost of operation is increased 8 8 Results dependant on strength of mesh 8 8 Fibroblast formation & collagen content  50% 8 8 Observations by Taylor & Lichtenstein

21 Junior / Average Surgeon Kux, Schemper, Burlinger, Piper, Belanger, Panos,Kingworth & many more surgeons reported, “In the hands of junior surgeons or that huge mass of general surgeons without expertise in Hernia surgery & operating in less than ideal conditions, the recurrence rate have been reported to be still very high ”

22 Demand of Junior Surgeons Inguinal Hernia is a bread & butter of junior surgeons DEMAND - Do not find an operation that converts recurrence rate from 2 % to 1% in the hands of experts BUT “to find an operation which is simple, safe, easy to learn & perform, does not require special material to repair & also gives recurrence rate less than 2% without any major complications during or after surgery”

23 Criteria of Modern Hernia Surgery 4 4 Simple, safe, easy to learn & perform 4 4 No risky / complicated dissection / suturing 4 4 No tension on tissues 4 4 Avoid using weakened muscles or fascia for repair 4 4 No foreign body / special material 4 4 Cost effective (in those days of cost ergonomy)

24 Criterias (Contd…) 4 4 Concept of “Come today - Go today” 4 4 Comfortable post op. period 4 4 Immediate ambulation 4 4 Rapid recovery to preoperative works efficiency (Rapidly evolving concept of managed health care) 4 4 Immediate or late complications to be comparable, if not, better than the established techniques

25 President: Royal College of Surgeons Sir Cecil Wakely said in 1948 that "A surgeon can do more for the community by operating on hernia cases and seeing that his recurrence rate is low than he can by operating on cases of malignant disease“ He said so because hernia is the commonest disease in the community With many post-repair complications

26  Unacceptable recurrence rate was the major hurdle of various surgical techniques described in the past. But the Introduction of  Lichtenstein mesh, mesh plugs, plug & mesh, PHS & endoscopes have all addressed well to the problems of recurrences, pain, infection & recovery But these problems are not yet completely over

27 Recurrence is reduced but it is still there Studies with longer follow up have shown 7-8% of recurrence rate in USA in spite of using a standard & costly mesh prostheses. Mesh plug— Pre-cut mesh

28 1)Pre-cut mesh is not at all used by all and some times a Bigger size mesh is cut & used to repair bilateral hernias. Cutting a mesh will reduce its strength. 2)Mesh shrinkage is more with low quality mesh used by some to save on the cost - Result is more recurrences 3)Post. Wall is not protected for 2-3 years till fibrous tissue is laid down and gains enough strength. 4)Loose suturing or too tight suturing of mesh invites more recurrences

29 Infection is reduced but it is still there 1)The bad part of this infection is that it does not respond to simple drainage procedures and we have to do a much larger surgery to take out the infected mesh completely. 2)Pus discharge, sinus formations, pain & repeated visits to doctors for months together and last advise of repeat surgery makes turmoil in the life of such patients and other family members.

30 “Post hernia repair pain syndrome is a major problem” 1)Deposition of fibrous tissue entraps nerves, vessels, vas difference and the surrounding muscles. 2)28-42% of patients in USA had to take medical treatment for pain & some of them even needs re-exploration. 3)Specialist doctors and clinics are established in USA to treat pain or to take out the mesh. This itself indicates the severity of those problems.

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32 From:YouTube Sent:Saturday, January 24, :32 AM To: herniaoperation drozdfather has made a comment on WHAT DAVID SAYS AFTER HIS OPERATION BY DESARDA TECHNIQUE: I wonder why they don't use this method other than in India. Seems so logical to do it that way. Possibly because the mesh must be big business for the makers of the mesh.

33 No Answer ??  Bassini & Shouldice repairs are basically & principally similar operations  Tantalum gauge or Dacron net Hernioplasty is also basically & principally similar to Lichtenstein mesh Hernioplasty  Mechanism of action to prevent recurrence is same but still later operations claim less than 1% recurrence rate -How ?

34 Scenario Today Scenario Today  Lichtenstein & Shouldice are two powerful lobbies in the world today - each claiming superior to the other  Periodically papers are published criticizing others technique & showing best results with their technique  The low rates from specialist centers seen may be due centers seen may be due to short periods of follow-up, to short periods of follow-up, differences in case mix, differences in case mix, and the skill of experienced hernia experts and the skill of experienced hernia experts Lichtenasteine Shouldice

35 RESULTING LOSSES WITH TODAY’S PROBLEMS ARE 1] LOSSES DUE TO RECURRENCES 2] LOSSES DUE TO RE- EXPLORATION REQUIRED FOR EXPLORATION REQUIRED FOR COMPLICATIONS OR PAIN COMPLICATIONS OR PAIN 3] LOSSES DUE TO LONGER TIME REQUIRED TO RESUME REQUIRED TO RESUME ‘NORMAL ROUTINE WORK' ‘NORMAL ROUTINE WORK'

36  All above factors result in to a loss of 7-8 million Pounds and 295 lost years of productivity in a small country like UK alone every year including the cost of mesh.  No organized data is available for India. 1% incidence and just 2% recurrence comes to a huge loss of 250 millions & lost years of productivity every year for a large country like India.

37 The Royal College of Surgeons states that  The best results are achieved by hernia expert surgeons & by the centres devoted to hernia surgery. BUT IN MY OPINION  Groin hernia is a commonest disease, so it can not remain a monopoly of a few hernia expert surgeons or specialized hernia centres for the best results.

38 To reduce those recurring losses Develop an operation technique which is 1. Simple & safe to do & learn by the resident surgeon also with good results 2. Does not use foreign body in any form 3. Does not use weak muscles & fascia 4. Early ambulation without much pain 5. Patient goes home in a day 6. Pt. is back to his work within a week 7. No major complications 8. NO RECURRENCE

39 “Recurrence free, no mesh-open inguinal hernia repair with continuous absorbable suture was a dream of every surgeon for a long time”

40 To achieve this let us understand the CONCEPTS OF ING. CANAL PHYSIOLOGY THAT PREVENT HERNIA FORMATION Conventional Concepts Conventional Concepts  Strength of the transversalis fascia  Obliquity of Inguinal canal  Shutter mechanism My Concepts My Concepts  Aponeurotic extensions make post wall strong  Musculo-aponeurotic structures play role by:- S -Shielding action+ C -Compression action+ S -Squeezing action (SCS Action) S -Shielding action+ C -Compression action+ S -Squeezing action (SCS Action)

41 CONVENTIONAL CONCEPTS Some questions of the physiology or factors that prevent hernia formation still exist. Some questions of the physiology or factors that prevent hernia formation still exist. 1] “Obliquity of the inguinal canal" is not a perfect description since the spermatic cord is lying throughout its course on the trans. Fascia alone. It does not pierce any muscle. 2]Repeated acts of crying & increased intra abd. 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 of the canal“. 3]Every individual with a high arch or a patent processus vaginalis does not develop hernia.

42 4] 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 REAL FACTORS  Then what are real factors that play a real role in prevention of hernia in normal individuals? OR recurrence after surgery?  The role played by the A poneurotic Extensions from the Transversus Abdominis Aponeurotic Arch in the posterior wall is important & that is not emphasized in the literature at all.

43 ANATOMICAL LAYERS 1] External oblique aponeurosis 2] Ing. Ligament + sp. cord with crem. Muscle + int. oblique & Trans. Abd. muscles. All + int. oblique & Trans. Abd. muscles. All those three structures are bound together those three structures are bound together by dense cremasteric fascia like one layer by dense cremasteric fascia like one layer 3] Posterior wall- Apo. Extensions + trans. fascia +(Falx inguinalis if present) fascia +(Falx inguinalis if present) 4] Pubic Ramus, Lacunar & Coopers ligament.  Myo-pectineal orifice is weak if Apo. Ext. are absent. Iliopubic tract alone is not of sufficient size to give complete protection In fact Apo. Ext. are inserted on this tract In fact Apo. Ext. are inserted on this tract

44 Myo-Pectineal Orifice- Post. Wall -Anterior view

45 Transversus Abdominis Aponeurotic Arch sending Aponeurotic Extensions

46 Scanty Aponeurotic Extensions seen

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49 ANATOMY OF ING.CANAL -post. view

50 POSTERIOR WALL  The posterior inguinal wall is composed of two layers. 1] The transversalis fascia & 2] aponeurotic extensions from the transversus abdominis aponeurotic arch 2] aponeurotic extensions from the transversus abdominis aponeurotic arch  The condensed transversalis fascia and aponeurotic extensions both give mechanical strength to the posterior inguinal wall to resist internal abdominal blows and prevent hernia formation  The strength of the posterior inguinal wall is directly related to the number of A poneurotic fibers it contains & not to the strength of the tr. Fascia alone.

51 TRANSVERSALIS FASCIA  Thus you will find that trans. Fascia hardly plays any role in prevention of hernia formation except at places where it is strengthened by additional fibrous condensation called as Iliopubic tract. Elsewhere Trans. Fascia is papery thin just as endo-abdominal fascia.  Proper cover of Apo. Ext. over this trans. Fascia gives real protection. And you will never find them in your hernia patients while operating. And you will never find them in your hernia patients while operating.

52 POSTERIOR WALL AT REST

53 POSTERIOR WALL (cont.)  Secondly, the posterior inguinal wall is kept physiologically active and dynamic due to those accompanying aponeurotic extensions & muscle contractions.  Muscular contraction of the transversus abdominis pulls this posterior wall and the aponeurotic extensions upward and laterally creating tension in it to prevent hernia formation (Physiologically dynamic action of the post. wall)

54 POSTERIOR WALL IN ACTION

55 POSTERIOR WALL (cont.) 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 muscle changes as per the force of the internal abdominal blow. This is important physiological phenomenon. The posterior inguinal wall should be described as an independent entity, playing an important role in the prevention of hernia formation, not only because of its mechanical strength but also because of its dynamic nature 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 muscle changes as per the force of the internal abdominal blow. This is important physiological phenomenon. The posterior inguinal wall should be described as an independent entity, playing 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 ing. hernias Such a physiologically dynamic & strong posterior wall is needed to be constructed to give 100% cure from the ing. hernias

56 APONUROTIC EXTENSIONS

57 MUSCULO-APONUROTIC STRUCTURES  47 % of individuals having full cover of Apo. Ext. will never develop hernia in their life time  If Apo. Extensions are absent or deficient (seen in 53% of individuals), then the trans. fascia alone can not resist the internal blows for a long period and herniation occurs  But all 53% individuals with absent or deficient Apo. Ext. do not develop hernia because of the additional role played by the strong musculo- aponeurotic structures around the ing. canal  ‘Shielding-Compression-Squeezing’ action of those musculo-apo. structures around the canal prevent herniation in such people with weak post. Wall (Article published in BMC Surg 03)

58 SQUEEZING ACTION OF CREMASTER MUSCLE

59 WHAT HAPPENS IN TODAYS OPERATIONS Bassini & Shouldice interpose a muscle curtain that gives physiological repair BUT If muscles are weak – Then it fails to give strength and protection. Lichtenstein puts a mesh –a mechanical barrier- BUT : It results in millions of micro abscesses, immense fibrosis, nerve entrapment, tissue damage & chronic pain.

60 BASSINI/SHOULDICE/MESH REPAIRS  Bassini/Shouldice interpose a muscle curtain. BUT if muscles are weak - no strength in post. wall - Recurrence  Lichtenst. puts a mesh-a mechanical barrier- BUT fibrosis affects the mobility of post. wall AND no additional muscle strength is given to weak muscles to increase strength of the post. wall. Post. wall is not physiologically dynamic-Recurrence

61 MESH REPAIR WORKS ONLY AS MECHANICAL BARRIER

62 Aetio - Patho - Physiology  Int. abd. blows like Coughing, Straining etc.  Post Wall resist int. abd. blows  Trans. fascia alone can not stand int. blows if Apo. ext. are absent or deficient. BUT STILL  Strong muscles around canal give protection  BUT Weak muscles + absent Apo. ext. then herniation takes place- because then herniation takes place- because int. ring & post. wall are not protected int. ring & post. wall are not protected & post. wall is not strong & post. wall is not strong

63 MUSCULO-APONUROTIC STRUCTURES(cont.)  If Apo. Ext. are absent or deficient AND muscles used for repair are also weak then recurrence is sure to take place Failures in today's Bassini/Shouldice repairs are seen in only those cases where muscles used are weak  “Therefore, any new approach to inguinal hernia repair must consider replacing Apo. element in the post. wall to make it strong and also give additional muscle strength to the weakened muscle arch to keep it physiologically dynamic”

64 SUTURES  Interrupted sutures are used to distribute the tension on suture line on all the stitches equally to avoid the disruption of sutures & resulting recurrence  Non absorbable sutures are used to give unlimited time for sutured tissues to heal  Interrupted sutures with non absorbable suture material has been a thumb rule in any hernia repair for this reason till today  Continuous suturing & that too with absorbable suture material was never even imagined by any body till today

65 NO MESH OPEN INGUINAL HERNIA REPAIR WITH CONTNIOUS ABSORBABLE SUTURES

66 UPPER LEAF OF EOA IS SUTURED TO INGUINAL LIGAMENT

67 UPPER BORDER OF SEPERATED STRIP IS SUTURED TO THE MUSCLE ARCH

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78 Mechanism of Action  Strip is fixed below & medially  All muscles exert action above & laterally  Ext. oblique gives additional strength to the weakened int. oblique & trans. abdominis  Contraction of those muscles increases the tone of the strip converting it into a shield to prevent herniation or recurrence  Tone of strip is graded as per force of muscle contractions (physio. dynamic wall)  Strip replaces the absent aponeurotic fibers giving a natural support to the trans. fascia

79 Mechanism of action that prevents recurrence

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83 Star Points of Technique  It is a Herniorrhaphy operation / plasty  Locally available live & active tissue  EOA is large enough to get strip easily  You get physio. dynamic post. wall  No difficult dissection is required  No foreign body or special material  Satisfies all criteria of modern Hernia surgery like day surgery, low learning curve, early ambulation, recovery in a week, minimal pain, no major complications and ZERO RECURRENCE

84 OUR STUDY  We operated on 1500 pts. during last 18 years with median follow up of 7 yrs  Continuous Absorbable sutures were used in more than 400 pts during last 5 years.  Median follow up period was 3.5 years  98.5% patients went home within 24 hrs.  95% pts started routine work in 3-4 days. Pts. could drive car and go to office.  Pt. can bend, squat, climb up a staircase, carry luggage & travel. Pts from abroad go back to their country on 3 rd day.  No recurrence & minor complications.1%

85 STATUS TODAY Today, this operation is being followed in many countries like Poland, Cuba, Ukraine, Albania, Libya, Iran, Brazil, Afghanistan, Russia, Korea, Yugoslavia, Uganda, Abu Dhabi, Pakistan, Sri Lanka, Myanmar, Imphal & many other countries Today, this operation is being followed in many countries like Poland, Cuba, Ukraine, Albania, Libya, Iran, Brazil, Afghanistan, Russia, Korea, Yugoslavia, Uganda, Abu Dhabi, Pakistan, Sri Lanka, Myanmar, Imphal & many other countries Surgeons from those countries have presented their papers on this technique showing same results & no recurrence Surgeons from those countries have presented their papers on this technique showing same results & no recurrence Web site and have been visited by more than 2-3 lac of people till today Web site and have been visited by more than 2-3 lac of people till todayhttp://herniasurgery.tripod.comhttp://www.geocities.com/desardahttp://herniasurgery.tripod.comhttp://www.geocities.com/desarda

86 “RECURRENCE FREE ING. HERNIA REPAIR WITH CONTINUOUS ABSORBABLE SUTURES LEAVING NO FOREIGN BODY IN SIDE THE PATIENT IS NO LONGER A DREAM BUT MAY BECOME A REALITY IN FUTURE”

87 REFERENCES 1. Millikan KW, Deziel DJ. The management of hernia. Considerations in cost effectiveness. 2. Williams M, Frankel S, Nanchahal K, Coast J, Donavon J. Hernia repair. In: Stevens A, Raftery J (eds) Health Care Needs Assessment. (1e). Oxford: Radcliffe Press, Anonymous. Activity and recurrent hernia [editorial]. BMJ 1977; 2: 3– Review] [33 refs]. Surgical Clinics of North America 1996; 76(1): 105– Kux M, Fuchsjager N, Schemper M. Shouldice is superior to Bassini inguinal herniorrhaphy. Am. J. Surg. 1994; 168: 15– Kark AE, Kurzer MN, Belsham PA. Three thousand one hundred seventy-five primary inguinal hernia repairs: advantages of ambulatory open mesh repair using local anesthesia. Journal of the American College of Surgeons 1998; 186(4): 447– Salcedo-Wasicek MC, Thirlby RC. Postoperative course after inguinal herniorrhaphy. A case-controlled comparison of patients receiving workers' compensation vs. patients with commercial insurance. Archives of Surgery 1995; 130: 29– Liem M, van Steensel C, Boelhouwer R, Weidema W, Clevers G, Meijer W et al. The learning curve for totally extraperitoneal laparoscopic inguinal hernia repair. The American Journal of Surgery 1996; 171: 281– Rattner D. Inguinal herniorrhaphy: for surgical specialists only? Lancet 1999; Webb k, Scott NW, GO PMNYH, Ross S, Grant AM on behalf of the EU Hernia Triallists Collaboration. Laparoscopic techniques versus open techniques for inguinal hernia repair (Cochrane Rebiew) In: The Cochrane Library, Issue 4, 2000, Oxford Update Software. 33

88 S ARE POURING FROM FOREIGN COUNTRIES From: Jan Guthrie Sent: Tuesday, January 04, :21 AM To: Subject: physicians in North America utilizing your new procedure Dr. Desarda, Congratulations on your revolutionary breakthrough in inguinal hernia repair. Have you trained any physicians in North America in this procedure? I have a patient who would very much like to have your procedure to correct his inguinal hernia. Thank you, Jan Guthrie Researcher The Health Resource, Inc.

89 S ARE POURING FROM FOREIGN COUNTRIES From: Wasilij Wlasow Date: Monday, December 05, :29 AM To: Prof.Dr.Desarda MP Subject: Letter for Desarda Dear Dr. M.P.Desarda Hello. My name is Sviatoslav. I was translator for you in Biskupin. I was very glad to see you. It was my dream to speak with you, real Desarda. And it came true. Thanks for your words about me. I will try to learn English better to speak with you in a future. We have many interesting photographs with you from Poland. And I have a little question for you. Would you like to find and send me E- mail few materials from literature about methods of treatment of femoral hernia in India. Because it necessary for my scientist work and is very difficult for me to find it in our country. We remember our visit to Poland & our acquaintance. We just successfully had used your method of hernioplasty in 9 cases of operation on 8 patients. We invite you to take part in the III-d Ukrainian Scientist-Practical Conference “Modern methods of surgical treatment of abdominal hernia”, which will take place on April 2006 in Kyiv city. And send you announcement about conference. Ministry of Public of Ukraine Ukrainian Association of Hernia Surgeons National Medical University by name O.O.Bogomolets Centre of surgery of abdominal hernia Yours truly V.Vlasov Yours truly V.Vlasov

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94 29th International Congress of the European Hernia Society. Athens, Greece, 6-9 V 2007 Autorzy: A[ndrzej] Kapała, J[acek] Szopiński, S[tanisław] Prywiński, J. Szmytkowski, S[tanisław] DąbrowieckiKapała SzopińskiPrywiński SzmytkowskiDąbrowiecki

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108 OPERATIVE WORKSHOP AT RAMOWY PROGRAM KONFERENCJI Czwartek 16 listopada : :00 Workshop: operacje przepuklin pachwinowych (przekaz z sali operacyjnej do hotelu Gromada): 1. Metoda Desardy (bez wszczepu syntetycznego) - S. Dąbrowiecki 2. Metoda Yalentiego PAD - G. Yalenti (Włochy); A. Opertowski 3. Laparoskopowa naprawa 1POM - S. Czudek (Czechy) 4. Metoda Lichtensteina (częściowo wchłanialna siatka Ultrapro) - A. Matyja 5. Absorbable Pług Gore (wchłanialny korek) - M. Śmietański 6. Prolene Hernia System (siatka przestrzenna prolenowa) - P. Ryli 7. Ultrapro Hernia System - (częściowo wchłanialna siatka przestrzenna) - J. Stanisławek

109 Speakers from different countries „Czy operacja Desardy jest alternatywą dla metod z siatką syntetyczną?" prowadzący: S.Dąbrowiecki, J.Szopiński, V. Ylasow V.V. Vląsov,, Our experience of herniorrhaphy by M. Desarda in inguinal hernia repair". K. Kometą „ Pierwsze doświadczenia w naprawie przepuklin pachwinowych metodą Desardy ". J. Orzechowski „ Wczesne wyniki operacyjnego leczenia przepukliny pachwinowej metodą Desardy J. Szopiński „ Zaproszenie do wieloośrodkowego badania klinicznego (RCTj nad porównaniem wyników leczenia przepuklin pachwinowych metodami: Desardy i Lichtensteina z zastosowaniem zaawansowanego oprogramowania internetowego ".

110 Desarda vs Shouldice study Zespół Opieki Zdrowotnej w Jędrzejowieul. Małogoska – 300 JędrzejówTel (Sekretariat) adresy - ZOZ 2. Oddział Chirurgii Ogólnej z Pododdziałem Ortopedycznym Ordynator – Lek. med. Władysław Sędek 2. Oddział Chirurgii Ogólnej z Pododdziałem Ortopedycznym Ordynator – Lek. med. Władysław Sędek Oddział liczy - 47 łóżek. Dzięki nowoczesnej bazie diagnostycznej i wyszkolonej kadrze medycznej wachlarz procedur chirurgicznych wykonywanych w Oddziale jest bardzo szeroki. Wykonuje się praktycznie wszystkie operacje w obrębie jamy brzusznej (z wyjątkiem zabiegów naczyniowych), łącznie z wielonarządowymi, resekcjami z powodów onkologicznych (np. operacja Whipple'a). Od 5 lat Oddział posiada zestaw do zabiegów laparoskopowych, który stosuje się do małoinwazyjnych operacji usunięcia pęcherzyka żółciowego z powodu kamicy lub do laparoskopowych operacji z powodu żylaków powrózka nasiennego. Przepukliny operuje się najnowocześniejszymi metodami beznapięciowymi (metoda Shouldice'a i Desarda), również z wykorzystaniem siatek polipropylenowych (metoda Lichtensteina). Zastosowanie tych metod znacząco obniża odsetek nawrotów i podnosi komfort pacjenta w okresie pooperacyjnym. W Oddziale wykonuje się również operacje Oddział liczy - 47 łóżek. Dzięki nowoczesnej bazie diagnostycznej i wyszkolonej kadrze medycznej wachlarz procedur chirurgicznych wykonywanych w Oddziale jest bardzo szeroki. Wykonuje się praktycznie wszystkie operacje w obrębie jamy brzusznej (z wyjątkiem zabiegów naczyniowych), łącznie z wielonarządowymi, resekcjami z powodów onkologicznych (np. operacja Whipple'a). Od 5 lat Oddział posiada zestaw do zabiegów laparoskopowych, który stosuje się do małoinwazyjnych operacji usunięcia pęcherzyka żółciowego z powodu kamicy lub do laparoskopowych operacji z powodu żylaków powrózka nasiennego. Przepukliny operuje się najnowocześniejszymi metodami beznapięciowymi (metoda Shouldice'a i Desarda), również z wykorzystaniem siatek polipropylenowych (metoda Lichtensteina). Zastosowanie tych metod znacząco obniża odsetek nawrotów i podnosi komfort pacjenta w okresie pooperacyjnym. W Oddziale wykonuje się również operacje

111 ORIGINAL ARTICLE PUBLISHED Videosurgery and Other Mini invasive Techniques 2006; 1: Artykuł oryginalny:Wczesne wyniki leczenia przepuklin pachwinowych sposobem Desardy u 17 operowanych chorych. Artykuł oryginalny:Wczesne wyniki leczenia przepuklin pachwinowych sposobem Desardy u 17 operowanych chorych. Artykuł oryginalny:Wczesne wyniki leczenia przepuklin pachwinowych sposobem Desardy u 17 operowanych chorych. A preferable method of inguinal hernia repair nowadays is the use of mesh graft in tension-free techniques. In the past few years a new technique developed by a surgeon from India, Mohan P. Desarda, was introduced. This method is based on the use of a strip of the external oblique aponeurosis which strengthens the posterior wall of the inguinal canal. Aim: To evaluate the initial results of Desarda’s inguinal hernia repair six months after the surgery. Material and methods: A group of 17 patients was analyzed. 15 male and 2 female patients

112 ORIGINAL ARTICLE imie i nazwisko osoby prezentujacej: Waldemar Kwiecieństopien naukowy: lekarz medycyny miejsce pracy:ddział Chirurgiczny Szpitala ZOZ w Jędrzejowie (woj. świętokrzyskie) autorzy zglaszanej publikacji: Waldemar Kwiecień Leszek Kania, Jerzy Prawda tytul zglaszanej publikacji: Wyniki leczenia przepuklin sposobem Desardy u 47 operowanych streszczenie publikacji: Celem pracy była ocena wyników leczenia przepuklin pachwinowych sposobem Desardy w Oddziale Chirurgicznym w Jędrzejowie od początku jej wdrożenia w czerwcu 2002 roku do końca roku 2004.

113 Informacja o wieloośrodkowym badaniu klinicznym Desarda vs Lichtenstein imie i nazwisko osoby prezentujacej: Waldemar Kwiecień stopien naukowy: lekarz medycyny miejsce pracy: Oddział Chirurgiczny Szpitala ZOZ w Jędrzejowie (woj. świętokrzyskie) imie i nazwisko osoby prezentujacej: Waldemar Kwiecień stopien naukowy: lekarz medycyny miejsce pracy: Oddział Chirurgiczny Szpitala ZOZ w Jędrzejowie (woj. świętokrzyskie) Published in 2005 Published in 2005

114 ORIGINAL ARTICLE Operacja Desardy jak możliwa metoda z wyboru w leczeniu przepuklinpachwiny. imie i nazwisko osoby prezentujacej: Orest Lerchuk stopien naukowy: lek.med. miejsce pracy: Szpital Wojewódzki we Lwowie. Klinika Chirurgii Ogólnej i Endokrynologicznej we Lwowie. imie i nazwisko osoby prezentujacej: Orest Lerchuk stopien naukowy: lek.med. miejsce pracy: Szpital Wojewódzki we Lwowie. Klinika Chirurgii Ogólnej i Endokrynologicznej we Lwowie. autorzy zglaszanej publikacji: Pawlowskyj Mychajlo, Lerchuc Orest, Markewich Yuri, Zaleskyj Igor autorzy zglaszanej publikacji: Pawlowskyj Mychajlo, Lerchuc Orest, Markewich Yuri, Zaleskyj Igor Study of 43 patients Study of 43 patients

115 Porównanie kosztów wykonania operacji przepukliny pachwiny metoda Desarda i Lichtensteina Piotr Cisowski stopien naukowy: Dr n. med. miejsce pracy: SU Bydgoszcz ulica: C. Skłodowskiej 9 miejscowosc: Bydgoszcz Porównano koszty wykonania zabiegu jednostronnej przepukliny pachwinowej metodą Dessarda i Lichtensteina na podstawie dostępnych w szpitalu zasad rozdziału kosztów opartych o system ICD 9 oraz na podstawie kosztów rzeczywistych. Dokonano również analizy zmian stawek płaconych przez monopolistycznego płatnika od roku 1999 w województwie kujawsko-pomorskim za operacje przepuklin.

116 PRESENTATION IN CUBA Organizan Sociedad Cubana de CirugíaPalacio de Convenciones AM VIERNES 10 DE NOVIEMBRE DEL 2006 TÉCNICA MOHAN DESARDA. UN NUEVO ENFOQUE EN LA REPARACIÓN DE LA HERNIA INGUINAL. DRS. PEDRO R. LÓPEZ RODRÍGUEZ, FELIPE R. LÓPEZ DELGADO, DR. HOSPITAL GENERAL DOCENTE “ENRIQUE CABRERA”. CUBA

117 VIII Spotkanie Polskiego Klubu Przepuklinowego 9-11 listopada 2007 Krakowie PRESENTATION VIII Spotkanie Polskiego Klubu Przepuklinowego 9-11 listopada 2007 Krakowie Operacja sposobem Desardy Przygotowaliśmy pokazową operację przepukliny metodą Desardy. Film nagrany w Klinice Chirurgii Ogólnej i Endokrynologicznej AM w Bydgoszczy trwa około 20 min, jest zaopatrzony w komentarz i szczegółowe wyjaśnienie metody. Dostępny w postaci płyty CD. Opłatę w wysokości 30 zł - należy wpłacić na konto: z dopiskiem "płyta Desardy" Zamówienie i informację o wpłacie proszę przesłać na adres Operacja sposobem Desardy Przygotowaliśmy pokazową operację przepukliny metodą Desardy. Film nagrany w Klinice Chirurgii Ogólnej i Endokrynologicznej AM w Bydgoszczy trwa około 20 min, jest zaopatrzony w komentarz i szczegółowe wyjaśnienie metody. Dostępny w postaci płyty CD. Opłatę w wysokości 30 zł - należy wpłacić na konto: z dopiskiem "płyta Desardy" Zamówienie i informację o wpłacie proszę przesłać na adres

118 Operacja przepukliny pokazowa M.P. Desarda 15 październik Transmisja z sali operacyjnej M. P. Desarda New concepts of inguinal hernia and its repair in perspective with and its repair in perspective with to days trend M. P. Desarda to days trend M. P. Desarda Wyniki leczenia przepuklin sposobem Desardy u 47 operowanych W. Kwiecień Desardy u 47 operowanych W. Kwiecień Doświadczenia własne w leczeniu przepuklin pachwiny met. Desardy. Kapala przepuklin pachwiny met. Desardy. Kapala Operacja Desardy jako możliwa metoda wyboru w leczeniu przepuklin pachwiny. wyboru w leczeniu przepuklin pachwiny. O. Lerchuk O. Lerchuk

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126 THANK YOU


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