Comment to: “Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study.” By Schjøth-Iversen L. (Hernia. 2017 Jul 27. doi:10.1007/s10029-017-1634-7. [Epub ahead of print])

Closure of Direct Inguinal Hernia Defect in Laparoscopic Hernioplasty to Prevent Seroma Formation: A Prospective Double-blind Randomized Controlled Trial

“…Therefore, the simple and easy technique by defect-closing is adequate to prevent the seroma formation for laparoscopic direct hernia repair and the results have indeed been extremely satisfactory in our study. Furthermore, the present hernia defect-closing technique has an additional advantage, as pointed by Li and Zhang, 14 this method reduces the recurrence risk after laparoscopic direct hernia repairs, especially when large pore lightweight weight mesh is used, and this method only closed the TF around the hernia defect, did not approximate the muscles together, thus, the tension was not undue. The present study also has some limitations.…”

Comment on “Heavyweight Mesh Is Superior to Lightweight Mesh in Laparo-endoscopic Inguinal Hernia Repair”

“…3 The benefits of this would be a reduction in postoperative complications with reduced positive margin rates along with maximized function for all patients. 5,6 We hope that this letter has answered to your comments. Further targeted or alternative contrasts with quantitative optical microscopy tools and future studies will support the use of this unique technology in the sarcoma surgical field.…”

“…First, about the recurrence mechanism. Unlike the recurrence after incisional hernias, which may be associated with the enlargement of defect, the mesh-fascia disruption, or multiple defects, the mechanism of inguinal hernia recurrence after laparo-endoscopic repair with LWM is largely due to mesh dislocation or mesh protrusion, 2,5 as it is more likely that a less strong LWM will protrude if the primary direct or indirect defect is large, which may occur in the early postoperative period, before the fibrotic response and subsequent fixation of mesh just stared, or occur gradually several months later. Consequently, the recurrent inguinal hernia was usually present with the same size as nonoperated, which indicates a technique failure.…”

“…6,7 Third, narrowing the defect before mesh placement. Since the increase recurrence was attributed to the mesh dislocation or protrusion into the defect cavity, 2,5 which is prone to occur in either direct hernia or large indirect hernia. Although LWM is more prone to migrate, the HWM can also protrude or slide into the large defect cavity as well, and result in hernia recurrence.…”

“…We are happy that you recognize the importance of our work and hopefully by using this new technology we can finally move forward. 1,5 The advantages of bringing these techniques into the clinic will allow surgeons to be more confident in removing sarcoma, sparing normal tissues whilst leaving a safe margin. ''Traditional surgeries'' still have high rates of complications and comorbidities for patients.…”