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Summer 2007

UCLA Becomes Home to Lichtenstein Hernia Institute

In this case, necessity really was the mother of invention. About 25 years ago, a doctor was trying to repair a hernia the same way surgeons had been doing it for more than a century— pulling the tissue together from either side to repair a weakness in the abdominal wall. This patient, however, didn’t have enough tissue. The surgeon needed another way.

So he took a piece of surgical mesh and covered the area of weakness to repair the hernia. From that seat-of-thepants ingenuity grew the Lichtenstein tension-free hernia repair technique, pioneered by the Lichtenstein Hernia Institute in 1984 and now considered the gold standard of care in hernia repair. Parviz Amid, M.D., is co-founder and director of the Lichtenstein Hernia Institute, now housed at UCLA in Westwood and Santa Monica. Dr. Amid has performed more than 10,000 tension-free hernia repairs and is teaching the next generation of surgeons.

A hernia is a weakness or hole in the musculature of the abdominal wall through which the contents of the abdomen, usually bowel or fatty tissue, bulge. For 100 years, repair involved stitching up the hole. It wasn’t always effective —10 to 30 percent of patients had to return for more surgery when the hernia recurred. “Imagine a pair of jeans with a hole in the knee. You stitch the hole up, but if you keep bending your knee, those stitches will break,” says Dr. Amid. “That’s because the fabric is not as strong where it ripped. The same is true with repairing hernias. You’re dealing with weak tissue. It’s like stitching through cheese.”

The Lichtenstein technique takes a lesson from tailors, patching the hole instead of sewing it closed. Doctors cover the weak area with a polypropylene patch or surgical mesh and sew or staple it into place. Within a month, the patient’s tissue grows into the mesh, strengthening the repair.

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