A clinical trial to determine whether a Lytle's repair of a primary indirect inguinal hernia needs the addition of a rectus flap an exercise in scientific method

Abstract

Abstract It is a paradoxical fact that although surgeons have discovered how to carry out organ transplants they have not disovered what is the best way to treat such very common conditions as early carcinoma of the breast and primary indrect inguinal hernia. The reason for this failue is that when surgeons talk of their dedication to scientific methods they refer to an archaic, fallacious, and discredited method; a method discarded by the physical sciences a very long time ago, It is called “Baconian empiricism”. The time is long overdue for this archaic method to be rejected and replaced in all surgical work by properly constructed clinical trials leading to an approved mathematical scrutiny of the observed results. The trial must be conducted in a way which eliminates bias for or against the rival methods being tested, otherwise the important mathematical tests of validity cannot be applied to the observed results. Evidence is submitted to show that more valid information can be obtained from a series of 155 cases of herniorrhaphy arranged in a scientific clinical trial than can be obtained from 2000 cases mechanically collected and tabulated in accordance with the rules of Baconian empiricism. This clinical trial is used as an example of the new scientific approach to the problem of the primary indirect inguinal hernia, but it applies equally well to the treatment of early carcinoma of the breast. The question asked was whether, having repaired the deep abdominal ring, a recutus flap ought to be added. The mathematical scrutiny of the observed results of the trial prove that this additional step would not improve the results obtained by a simple suture of the deep ring on its own.