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New theory that prevents groin hernia formation

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New theory that prevents groin hernia formation Powered By Docstoc
					BASED ON THE NEW CONCEPTS OF
PHYSIOLOGY OF ING. CANAL THAT
 PREVENT HERNIA FORMATION
   PROF. Dr. Desarda M. P.
       M.S.(GEN.SURG.);FICS(USA);FICA(USA)
  HERNIALOGIST & GENERAL SURGEON

1. CHIEF, HERNIA CENTRE, POONA
   HOSPITAL & RESEARCH CENTRE
2. PROF. EMERITUS, GALAXY CARE GROUP
   OF HOSPITALS, PUNE
3. EX-PROFESSOR OF SURGERY AT
   KAMALA NEHRU GENERAL HOSPITAL
4. EX-ASSO. PROFESSOR OF SURGERY AT
   BHARATI VIDYAPITH MED. COLLEGE
  RECALL MEMORY ABOUT ING.
     CANAL PHYSIOLOGY
 Groin hernia is the commonest surgery
 performed world wide by junior as well as
 senior surgeons. The incidence ranges from 2-
 5%. Therefore this disease is highly rated in
 health care industry. Endeavor to give a simple
 and recurrence free hernia repair is going on.
 AND TO ACCOMPLISH THIS WE MUST
 RECALL OUR KNOWLEDGE ABOUT THE
 CONCEPTS OF ING. CANAL PHYSIOLOGY
 LAID DOWN IN OUR TEXT BOOKS THAT
 PREVENTS HERNIA FORMATION
   OLD THEORIES THAT PREVENT
    GROIN HERNIA FORMATION
1] Obliquity of inguinal canal: It means the
  spermatic cord pierces the 3 abdominal
  muscles at 3 different levels obliquely.
 OLD THEORIES THAT PREVENT
  GROIN HERNIA FORMATION
2] Shutter mechanism at
 internal ring: Medial border of
 int. ring is pulled upwards and
 laterally to close the int. ring
3] Shutter mechanism at canal
 level: Oblique fibers of the muscle
 arch moves downwards and
 medially to go close to the inguinal
 ligament.
SHUTTER MECHANISM AT
RING & AT CANAL LEVEL
  OLD THEORIES THAT PREVENT
   GROIN HERNIA FORMATION
4] High muscle arch: It means the distance
  between the muscle arch and inguinal
 ligament is more.
5] Patent processus vaginalis: It means
 hernia is formed because there is patent
 processus vaginalis since birth.
6] Strength of the Transversalis Fascia:
  All these theories are mentioned in
  various text books since last almost
               one century
BREAKTHROUGH IN THOSE ONE
  CENTURTY OLD THEORIES
WE HAVE THROUGH OUR RESEARCH
SCRAPPED THOSE ONE CENTURY
OLD THEORIES
            AND
WE HAVE POSTULATED AND
PUBLISHED THAT THOSE THEORIES
ARE NOT TRUE AND PERFECT
           BECAUSE
       THE REASONS ARE
1] Obliquity of Inguinal Canal is not
 true because the sp. Cord lies on
 the Trans. Fascia through out its
 course from int. ring to ext. ring &
 does not pierce any muscle.
2] Obliquity of Inguinal Canal and
 shutter mechanism are almost
 absent in new born babies BUT still
 every baby does not develop hernia
 in spite of repeated acts of crying
        THE REASONS ARE
3] SHUTTER MECHANISM AT INT. RING
 LEVEL AND CANAL LEVEL: There is a
 movement upward and laterally at ring
 level and downward and
  medially at canal level.
This is not possible because
the same muscles of muscle
arch can not move in opposite
direction as stated above at the same time
and within a narrow distance of just few
inches
        THE REASONS ARE
4] Every patient with high muscle arch or
 patent processus vaginalis do not develop
 hernia
5] None of those old factors are restored in
 the traditional operations BUT still almost
 90% of patients are cured
6] Chr. Cough, straining or a job of weight
 lifting also can not be real aetiological
 factor because every asthmatic patient or
 every Cooley on Railway platform do not
 develop hernia
      THE REASONS ARE
7] The strength of the Trans. Fascia
is just not true because the Trans.
Fascia is papery thin and can not
give any protection as stated every
where. But still such photographs
are demonstrated by the Sr. teachers
    NEW CONCEPTS OR
THEORIES PUBLISHED BY US
      IT MEANS THESE THEORIES
    DESCRIBED AND BELIEVED TO BE
   TRUE FOR ALMOST A CENTURY ARE
    REALLY NOT TRUE AND CORRECT
                THEN
   WHAT ARE THE REAL FACTORS OR
    THEORY THAT PREVENTS HERNIA
      FORMATION IN THE NORMAL
            INDIVIDUALS?
     NEW CONCEPTS OR
 THEORIES PUBLISHED BY US
Aponeurotic Extensions from the
    Transversus Abdominis
       Aponeurotic Arch
in the posterior wall of the ing. canal
      is important real factor that
    prevents hernia formation in the
         normal individuals AND
        Hernia formation takes place
  only if they are absent or deficient
ANATOMY OF ING.CANAL -post. view
 TOTAL COVER OF APO. EXT. IN
NORMAL CANAL WITHOUT HERNIA
Transversus Abdo. Apo. Arch sending
Aponeurotic Extensions-No full cover
Hernia seen through scanty Apo. Ext.
Hernia seen through Scanty Apo. Ext.
POSTERIOR WALL OF ING. CANAL
     IT IS MENTIONED IN EVERY TEXT
    BOOK AND STATED BY EVERY BODY IN
    LECTURE OR RESEARCH ARTICLES
    THAT THE POST. WALL OF ING. CANAL
    IS FORMED BY THE TRANS. FASCIA.
    AND THAT THE PRVENTION FROM
    HERNIATION DEPENDS ON THE
    STRENGTH OF THE TRANS. FASCIA.
      WE HAVE POSTULATED AND
     PUBLISHED THAT THIS IS ALSO
             NOT TRUE.
           POSTERIOR WALL
 The  post. Ing. wall is composed of two
  layers. 1] The transversalis fascia is first
  layer & 2] Aponeurotic ext.
  from the Trans. Abd. Apo.
  Arch. Is second layer.
  The so called Iliopubic tract is also a part
  of this Apo. Ext. and not a condensation
  seen in Trans. Fascia as believed
 The Apo. extensions give mechanical
  strength to the posterior inguinal wall to
  resist internal abdominal blows and
  prevent hernia formation
         TRANSVERSALIS FASCIA
 Thus you will find that trans. Fascia
 hardly plays any role in prevention of
 hernia formation. Trans. Fascia is papery
 thin just as endo-abdominal fascia.
 Proper cover of Apo. Ext. over this
 trans. Fascia gives real protection.
 Thestrength of the posterior inguinal
 wall is directly related to the number of
 Aponeurotic fibers it contains & not to
 the strength of the tr. Fascia as stated in
 every Text Book
POSTERIOR WALL AT REST
     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)
POSTERIOR WALL IN ACTION
          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
   Such a physiologically dynamic & strong
    posterior wall is needed to be constructed
    to give 100% cure from the ing. hernias
NO MESH INGUINAL HERNIA
 REPAIR WITH CONTNIOUS
  ABSORBABLE SUTURES
  BASED ON THOSE NEW
CONEPTS PUBLISHED BY US
Mechanism of action that
  prevents recurrence
Mechanism of action that
  prevents recurrence
        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
              OUR STUDY
 Operated  on 2000 pts. during last 20 yrs.
 Continuous Absorbable sutures were used
  in more than 800 pts during last 8 years.
 Median follow up period more than 7-8 yr
 98.5% patients went home within 24 hrs.
 95% pts started routine work in 3-8 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 3rd day.
 No recurrence, minor complications <1%
            STATUS TODAY
 Today, this operation is being followed in
  many countries like USA, China, Germany,
  Russia, Poland, Cuba, Mexico, Ukraine,
  Albania, Libya, Iran, Brazil, Afghanistan,
  Korea, Yugoslavia, Uganda, Abu Dhabi,
  Pakistan, Sri Lanka, Myanmar, Imphal &
  many other countries
 More than 80 papers are presented or
  published by different surgeons all over
  the world. And more than dozen are RCT
 We have established more than 60
  centers globally out of which 7 are in USA
  where this operation is routinely followed
“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”
                                     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, 1994. 8
3.    Anonymous. Activity and recurrent hernia [editorial]. BMJ 1977; 2: 3–4. 10

4.    Review] [33 refs]. Surgical Clinics of North America 1996; 76(1): 105–116. 11
5.    Kux M, Fuchsjager N, Schemper M. Shouldice is superior to Bassini inguinal herniorrhaphy. Am. J.
      Surg. 1994; 168: 15–18. 12
6.    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–
      455. 22
7.    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: 29–32. 23
8.    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: 281–285. 29
9.    Rattner D. Inguinal herniorrhaphy: for surgical specialists only? Lancet 1999; 354. 32
10.   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
         EMAILS ARE POURING FROM
           FOREIGN COUNTRIES
     From: Jan Guthrie [j.guthrie@thehealthresource.com]
         Sent: Tuesday, January 04, 2005 7:21 AM
                  To: desarda@lycos.co.uk
    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.
                www.thehealthresource.com
     EMAILS ARE POURING FROM FOREIGN
                COUNTRIES
                             From:    Wasilij Wlasow vvlasov@mail.ru
                          Date:    Monday, December 05, 2005 9:29 AM
                        To:      Prof.Dr.Desarda MP desarda@hotmail.com
                                    Subject: Letter for Desarda
                                     Dear Dr. M.P.Desarda
                                    I was very glad
 Hello. My name is Sviatoslav. I was translator for you in Biskupin.
  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 14-15 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
OPERATON VIDEO
POST OPERATIVE RECOVERY WITHIN 24 HOURS
POST OPERATIVE RECOVERY WITHIN 24 HOURS
THANK YOU

				
DOCUMENT INFO
Description: New theory about inguinal canal physiology and New method of tension free simple inguinal hernia repair without mesh, drive car next day, day surgery hernia operation, no mesh, no complications, no recurrence, local, followed in many countries, “Dr. Desarda Repair” for inguinal hernias without mesh