Editor—Kingsnorth has misrepresented the role of the laparoscopic hernia repair in his article.1 A clinician reading this who has no experience of surgical options for inguinal hernia repair may come away with the impression that laparoscopic repair has largely been dismissed by the surgical community and the National Institute for Clinical Excellence (NICE).
Kingsnorth reports that the incidence of chronic groin pain after hernia repair has now overtaken that of hernia recurrence, without making it clear that among the various advantages of laparoscopic hernia repair (less postoperative pain and earlier return to normal activity) chronic groin pain almost never occurs.
The rare but serious complications that he quotes from the European Union's hernia trialists collaboration were for transabdominal pre-peritoneal hernia repairs (as opposed to totally extra peritoneal repairs),2 which are not currently recommended by NICE.
The article did not highlight the fact that laparoscopic repair is recommended by NICE for bilateral and recurrent hernia repair. The main objections to laparoscopic repair for primary hernias are apparently financial and not clinical.3
Interestingly the illustration of mesh in the preperitoneal space is the mesh placement for laparoscopic not open repairs, although this is not stated in the text. This may further mislead readers who are not aware of these differences into believing this represents mesh replacement for open hernia repair.
Kingsnorth oversees a hernia unit at Plymouth that deals exclusively with open hernia repairs. This might be regarded as a competing interest.
Competing interests: PMP performs both open and laparoscopic hernia repairs of the totally extra peritoneal type.
References
- 1.Kingsnorth A. Treating inguinal hernias. BMJ 2004;328: 59-60. (10 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2.EU Hernia Trialists Collaboration. Laparoscopic compared with open methods of groin hernia repair: systematic review of randomised controlled trials. Br J Surg 2000;87: 860-7. [DOI] [PubMed] [Google Scholar]
- 3.National Institute for Clinical Excellence. Guidance on the use of laparoscopic surgery for inguinal hernias. London: NICE, 2001. (Technology appraisal guidance No 18.)