Laparoscopic transabdominal preperitoneal hernia repair can be accomplished with operative and hospitalization times and a short-term recurrence rate similar to those of an established open technique. Perioperative exercise testing may be an important adjunct to return to work in the comparison of methods.

sue of the Archives. In their article, the authors indicated that in their control group (group 1) a tension\x=req-\ free technique similar to that described by Lichtenstein et al and Amid et al2 was used. The comparative study is flawed for several important reasons. First, the open tension-free procedure that was described by Payne during his talk at a hernia symposium in Indianapolis, Ind, in June 1993 was the original Lichtenstein procedure prior to its modifications many years ago. The modifications were based on our clinical observations and served to reduce the postoperative pain and recurrence rate. The changes, however, were not published until March 1993,2 7 months after Payne et al began their study. Therefore, the procedure used in the comparative study is not the current Lichtenstein tension-free repair. Second, in mak¬ ing a statement about a 4to 6-week recovery period fol¬ lowing open operations, Payne referred to one of our pubtications.2 However, no such recovery period was mentioned in our article. Third, the authors have been inconsistent in reporting the operative time of their ver¬ sion of open tension-free repair. The reported time, in their different publications, varies from 73 minutes to 56 minutes and 63 minutes. The average time for perform¬ ing the Lichtenstein open tension-free hernioplasty is 25 to 45 minutes depending on the complexity of the pro¬ cedure. While the operating room time for the authors' laparoscopie repair is consistent with that of others, the reported time for their open repair is excessive. There¬ fore, their extra operative time and surgical trauma should be considered in relation to postoperative pain, recov¬ ery period, and the all-important cost analysis. And fourth, return to work after open tension-free repair reported by the authors (mean of 17 days) is not consistent with that reported internationally by other authors (2 to 14 days).3We congratulate Payne and his colleagues for their study. However, we believe that your readership should be aware of the above to make a fair and intelligent ap¬ praisal. roscopic or open inguinal herniorrhaphy? a randomized prospective trial. Arch Surg. 1994;129:973-981. 2. Amid PK, Shulman AG, Lichtenstein IL. Critical scrutiny of the open 'tension\x=req-\ free' hernioplasty. Am J Surg. 1993;165:369-371. 3. Amid PK, Shulman AG, Lichtenstein IL. A critical comparison of laparoscopic hernia repair with Lichtenstein tension-free hernioplasty. Med J Aust. 1994;161:239-240. In reply We are pleased to respond to the points raised by Amid et al. First, our article clearly states that the repairs in our control group were performed in "a tension-free manner similar to that described by Lichtenstein et al and Amid et al."1 One of us (J.H.P.) recently visited the Lichtenstein Institute to observe their technique. No significant differences were noted. Second, while the truth of this statement is well recognized, the correspondents' 1993 article did not make reference to it. Third, as reported in our article,1 the average operating tim...