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Aug 2011

Fixing the Mesh in Inguinal Hernia Repair: Where Do We Stand?—Reply

Author Affiliations

Author Affiliations: Department of Surgery, Skaraborg Hospital, Falköping, and Department of Clinical Science, Interventions, and Technology, Karolinska Institutet, Stockholm, Sweden.

Arch Surg. 2011;146(8):992-993. doi:10.1001/archsurg.2011.191

In reply

We thank Drs Garg and Nain for their appreciative comments on our article about hernia mesh fixation (HMF) in the Lichtenstein inguinal hernioplasty (hereafter called Lichtenstein), and their enlarging questions about glue or no HMF in Lichtenstein as well as in laparoscopic totally extraperitoneal repairs (TEP).

Our study only included Lichtenstein, because it is the most common and most standardized of hernia repairs. This made possible valid multiregression analysis to exclusively assess the relative influence of different suture materials. Our study revealed no significant difference in risk for reoperation after HMF with nonabsorbable or long-term absorbable sutures, whereas short-term absorbable sutures more than doubled that risk. The registered repairs with glue or no HMF were too few to attempt meaningful statistical analysis. Still, we agree with Drs Garg and Nain that nonfixation is not a valid option for Lichtenstein. However, we are convinced that not all such attempts would fail.

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