Reply To: The Nuremberg Code and the ethics of the secret ‘Kang Repair’
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In honor of the fact that the indirect inguinal is the most frequent hernia type, I’ll address your request indirectly by quoting the Gibbium Hospital’s explanation of the Kang Repair.
“Kang repair for indirect hernia is similar to the one described by Dr. Marcy in the past, but modified to avoid the high recurrences. In fact, most of the internal inguinal ring is occupied by the spermatic cord which contains the testicular vessels, lymphatics and sensitive nerves. So it is very difficult to close the internal inguinal ring securely without damaging the aforementioned sensitive structures. That is why this new sort of procedure has not been developed until now. Kang repair for direct hernia also modified the older posterior wall repair methods to minimize damage to surrounding structures and to make the repair stronger. In Kang repair for direct hernia, the scope of surgery has been much smaller than in the older posterior wall repairs including Shouldice or Desarda. In conclusion, another characteristic of Kang repair is that it minimizes the scope of surgery and closes the hernia hole directly.”
We are told that the Kang Repair for indirect hernias is “similar to the one described by Dr. Marcy, but modified to avoid the high recurrences”. Thus we have a reference to a standard well-defined procedure, the Marcy procedure, but the modifications of the procedure are not specified. How is the patient/subject supposed to assess what will be done to them? Is it rational? What is the evidence that the modifications have the intended benefits? What are the potential complications? Why are they kept secret? Is that ethical to keep the patient/subject in the dark? I don’t think so!
To be more direct regarding the relevant standard indirect procedure, a useful resource is the textbook “Hernia” edited by Lloyd M. Nyhus and Robert E. Condon (see the contribution discussing the Marcy Repair).