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Sir,
I read with interest the article ‘Mairs Repair for
Inguinal Hernia’ by Rohit P Joshi et al on the internet. This study was
undertaken by the authors in the year 2005 or earlier and the results were
published in the year 2005. I do not agree with the author’s views that
Mairs repair is safe and efficient. It may be simple and cost effective but
the complications and recurrences following Mairs repair have already made
to abandon this repair from the world map long back. The author recommended
this repair for the lower socioeconomic strata with a monthly income of $20
(Rs.800/- approximately). How is he going to decide the real income of any
body who poses to have income less than Rs.1000/- per month? If he is
really poor and can not afford the cost of mesh then better to treat him on
charitable basis and use any other methods of repair like Bssini/Schouldice
repair, which gives equivalent or much better results, instead of putting
patient to all sorts of complications due to skin graft like necrosis,
infection, cyst formations, recurrences, etc. without any added advantage.
In my repair, a strip of the external oblique aponeurosis goes behind the
cord to form a new posterior wall. After excision of the sac, a strip of
the external oblique aponeurosis (EOA) is partially separated from its
medial leaf, keeping its continuity intact at either end. This undetached
strip of EOA is sutured to the inguinal ligament below and the arch of
muscle above, behind the cord, to form a new posterior wall. This strip is
put under tension by muscular contraction and works as a shield to prevent
recurrence. External oblique muscle gives additional strength to the
weakened muscle arch to keep this strip physiologically dynamic. I have
recently published an article ‘Physiological repair of inguinal hernia-A
new technique (Study of 860 patients) in ‘The World Journal of Hernia and
Abdominal wall surgery’.1 The 0% recurrence rate, minimal pain, one night
stay and complete recovery in 1-2 weeks time is seen because this repair is
based on the physiological principle and not on the anatomical principle as
seen in the mesh repairs. Today, this operation is being followed in many
countries like Poland, Cuba, Ukraine, Korea, Albania, Libya, Brazil,
Yugoslavia, Russia, Afghanistan, Iran and some countries in central and
east Africa. Now, since last 4-5 years, I am operating all cases with
continuous absorbable sutures, which saves time and one packet of suture
material, a great saving, with equally excellent results. Preliminary
results of this study are already published in the ‘Asia Pacific Hernia Congress
2006’ held in New Delhi. It was never thought by any body till today that
it will be possible to use continuous and that too absorbable sutures in
repairs of inguinal hernias. This was possible in my repair because there
is no tension on the sutures and it is based on the physiological
principles. I request the authors and the readers to take trials of this
technique instead of going back to an abandoned technique. This article and
this letter to the editor assume importance because it is published by
consultants from a hospital of high repute and known to have quality
research. I personally feel not to hurt any body by this letter.
Reference
1.
Desarda MP. Physiological repair of inguinal hernia - A
new technique, Study of 860 patients. Hernia 2006; 10 : 143-6.
MP Desarda
Professor and Consultant General Surgeon, Department of
Surgery, Poona Hospital and Research Centre, Pune.
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