Letter to Editor by Losanoff et al.: reply (Physiological repair of inguinal hernia: a new technique)


I am thankful to J. E. Losanoff M.D. and J. Michael Millis, M.D. for reading my article with interest. I have gone through their comments carefully. Their statement that ‘‘The overlap in follow-up time among the series is confusing and demands an explanation....’’ is probably because they have overlooked my explanation given about this in the ‘Introduction’ section itself. The drawback of poor long-term follow up in previously published series is removed in this series. So it will be nice if we concentrate on results of this series. The statement that ‘‘We find no evidence .... his results are superior to that of previously published series of mesh repair.’’ is also probably because they have overlooked the 0% recurrence rate observed in the median follow up period of 7.8 years of this series. I have mentioned in the article about my personal communications with many other surgeons from other countries and given their email addresses for verification. The results observed by them also show 0% recurrence in their locally published series. Secondly, a pure tissue hernia repair does not need any justification like ‘‘Modern monofilament prosthetic materials resist infection, have a negligible suppuration rates, and excellent tissue incorporation’’, as it does not use any foreign body. My operation technique gains on this count also. I do agree with the above statement about the quality of modern mesh. But, if given a technique of inguinal hernia repair having comparable, if not superior results, what will anybody choose for himself -a pure tissue repair or a mesh (foreign body) repair? The statement that-‘‘The recent literature .... pathological changes in collagen, .... that sets the stage for the development of a hernia’’ is not relevant to this article because it is a description of a new technique of hernia repair and not its etiological factors. However, I agree with their further statement that-‘‘Numerous ... trials ....superiority of the tension-free mesh repair over the traditional tissue approximation method’’. This is true because the traditional tissue approximation methods use transversus abdominis and internal oblique muscles for repair even if they are weak. Therefore, I have stated in my article that ‘‘The aging process is minimum in tendons and aponurosis and therefore it is the best alternative to mesh’’ (Instead of Shouldice or other pure tissue repairs). ‘‘A number of such repairs described in Lason’s classic 1941 text are similar....... Madden [16], Koontz [17], Calman [18], and Halsted [16] all describe variants of inguinal floor repair similar to the one described in the Desarda articles’’. I do not agree with those statements because Shouldice operation is similar to or a variant of Bassini operation; various mesh repairs like PHS are variants of the original Lichtenstein mesh repair but still they are not only accepted but are promoted. I still maintain that my operation technique is neither similar to or a variant of all above-mentioned operations, because none of them have ever used the strip of external oblique aponurosis (EOA) as described in my technique. No operation described to date has ever used the concept of giving additional muscle strength to the weakened muscles of the inguinal canal. The sutured strip of EOA in my operation becomes an independent entity as the posterior wall of the inguinal canal, which is kept physiologically dynamic as per the force of contraction of the muscles. This posterior wall is strong because of the nature of the strip and it is also M. P. Desarda Department of Surgery, Poona Hospital and Research Centre, Pune, India

DOI: 10.1007/s10029-006-0077-3

Cite this paper

@article{Desarda2006LetterTE, title={Letter to Editor by Losanoff et al.: reply (Physiological repair of inguinal hernia: a new technique)}, author={Mohan P. Desarda}, journal={Hernia}, year={2006}, volume={10}, pages={200-201} }