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Lichtenstein Repair Wrong Ways – Dr. Chen
Here is another video from the Costa Rica conference. Strange how somebody decided to create these short videos and publish them. Kind of common in the trades world, like at a paint conference, but seems a bit casual for a medical conference.
The video does not really increase confidence in the field of hernia repair as a whole. Dr. Chen describes how there are hundreds of different ways that people “modify” the Lichtenstein repair. At the end you realize that it is still really a major gamble to have a hernia repaired, anywhere. No real standards to measure against, just a bunch of surgeons freestyling out there. This how I do it, I do it this way, I like this technique, etc. But nobody is measuring efficacy or long-term results.
Also interesting that Dr. Pauli framed the question as what was wrong in the instance of a recurrence, but Dr. Chen included nerve entrapment.
It’s only three minutes long.
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4 Replies
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My case has a very poignant relation to this issue. During the preoperative talk it was said that I would have a Lichtenstein repair with a flat 2D mesh, illustrated by a corresponding graphic on the signed informed consent sheet.
However during the actual surgery an Ethicon UHS was used, which not only isn’t a flat mesh obviously but also is explicitly not the Lichtenstein technique as detailed on the informed consent sheet. On there, a surgery like the one I actually got was classified as the seperate Gilbert technique, which was explicitly crossed out. As far as I can tell, Gilbert’s original technique was using a plug and patch, so not exactly the same as a UHS but in some regards more similar than a flat mesh.
My legal case against my surgeon is pending -in part- on that being considered a violation of the consent to surgery, which in turn would legally make it an armed assault. There are other possible legal violations but that’s basically the central one.
For reference, I’m German so this is pertaining to German law and some of the terminology I used might not be correct legally, especially considering it’s translated by me.
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The original Lichtenstein technique and the Amid modification (which is what I use) are the best techniques for safe and effective hernia repair. And both have data to support them.
The reality is, similar to the Shouldice, Bassini, and laparoscopic repairs, many surgeons tweak these otherwise standardized repairs.
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Good Intentions:
I have watched a few inguinal hernia repair videos on the internet. One of these videos shows a surgeon using staples to fixate the mesh during a “Lichtenstein” repair. I don’t think this is acceptable practice.
Here is a link to Dr. Chen’s presentation “Open Lichtenstein – How and when I do it” at the 2017 Sages Convention.
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Thank you for sharing this. I had both my left and right inguinal hernia repairs at the UCLA Lichtenstein Hernia Clinic in 2016 where Dr. Chen teaches. When he said “we do bad things all the time but fortunately the human body is forgiving” it sorta shows what a mess this procedure is.
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