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What would Lichtenstein do? – past and present
I have commented about how the proliferation of new materials and methods is all predicated on using the 510(k) process for materials, and just “winging it” for new methods. Try it and see, best guess, the latest and greatest technology.
Lichtenstein actually had to do a very thorough and complete study to get his new material and procedure accepted. I wondered what he was doing before he chose to try mesh prostheses. I found an old paper from 1964 that is interesting. Some of the forum members who know the various techniques and anatomy might be able to place a name-type on his method.
If you read the paper you will notice almost the exact thoughts that are used today to describe hernia repair goals. Back to work quickly, walk out of the clinic, outpatient surgery. This was 58 years ago.
Irving Lichtenstein died 21+ years ago. I wonder what he would think about what’s happening today, most of it derived from his original work.
I have looked for what he was doing in the 70’s and 80’s before he ventured in to prosthetics. It would be interesting to see what his last suture technique was before he made the switch, and what his thoughts were about using prosthetics on everybody with a hernia. Did he advise pure tissue repair for certain patients?
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1515137/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1515137/pdf/califmed00080-0023.pdf
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2 Replies
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Yes, he was doing pure tissue repairs, but I don’t know anatomy or the details of the different to be able to identify what he was doing.
I read several of his papers and abstracts of papers over the years. Also those of several other surgeons. It’s fascinating how they can write about doing thousands of repairs over many years, tracking the results, via interviewing past patients, and drawing conclusions for their communications. As opposed to today where some doctors publish conclusions after 31 patients and two years of time, and voila, a new product is on the market, ready for use everywhere.
It looks like Dr. Lichtenstein was trying to solve the problem of recurrences, mainly. He went through a polypropylene fiber “plug” phase also, similar to the Kugel repair, I believe, except that there was no onlay patch associated. I didn’t get the details, many of those old publications have to be paid for. The American Medical Association has to get paid to share the knowledge.
I found some early papers that suggest that Lichtenstein was convinced that there was a “better way”. This one is from 1976. Very ironic in that we have new “sacred principles” and a new failure to improve. History repeats.
https://www.sciencedirect.com/science/article/abs/pii/0002961076903810
From the abstract –
“Sacred principles guiding surgical repair of groin hernias have remained basically unaltered since their inception. This may explain the failure of results to improve significantly over the years. ”
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That’s really interesting, so Lichtenstein did tissue repairs initially? Have I got that right?
But they weren’t Shouldice or Desarda?
Strangely enough my dad told me during a chat we had last week one of his friends had hernias repaired both sides, years ago. He didn’t think mesh was around then and his friend was “back to normal” almost immediately.
I wondered what method they’d used before mesh.
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