No abstract

Lightweight polypropylene mesh may be preferable to heavyweight mesh for TEP inguinal hernia repair because it provides less postoperative foreign body sensation; however, there was no significant difference in the incidence of chronic pain.

An anomalous elongated pancreaticobiliary common channel encourages reflux up both the biliary tree and the pancreatic ductal system, resulting in progressive choledochal dilatation, cholangitis with ductal calculi, relapsing pancreatitis and malignant change. Transduodenal sphincteroplasty has been used to improve drainage from the abnormal channel. The use of endoscopic sphincterotomy (ES) to establish drainage and minimize the surgical risks is reported in six symptomatic patients with mild choledochal dilatation (common bile duct diameter less than 15 mm), a common channel less than 15 mm in length and a distal stenosis. This was successful in five patients, who have no further symptoms. ES failed in the only patient with an undilated common channel and this patient went on to have open surgery. We believe ES to be safe and effective in the treatment of selected cases of long common channel.

Correspondence La pa roscopic append icectomySir I was delighted to read the excellent Leading Article by Messrs Loh and Taylor ( B r J Surg 1992; 79: 289-90). There is no doubt that laparoscopic appendicectomy is often easier than laparoscopic cholecystectomy, provided the right technical approach is learnt and subsequently developed. The difficulty has been that most appendicectomies in this country are performed as an emergency, and in the first few cases the 'learning curve' means that the procedure will take of the order of 1 h 30 min to 2 h and in some units over 4 h. This

No abstract