Authors' reply: Risk of recurrence 5 years or more after primary Lichtenstein mesh and sutured inguinal hernia repair (Br J Surg 2007; 94: 1038-1040).

摘要

We thank Drs M Nowack and J Metzger for their interest in our paper, allowing a clarification of uncertainties raised by the authors. Compared with inguinal indirect hernias, direct inguinal hernias are more prone to recurrence after sutured repair. We reported a bias distribution in our material (n = 47975 repairs) of hernia type in sutured versus mesh repair. Within the group of sutured repairs 75-9 per cent were for an indirect hernia and in mesh group 54 per cent for an indirect hernia. Although not reported, there was no overlapping of 95 per cent confidence intervals (c.i. 74-4-74-8 versus 53-4-53-5 per cent). Thus, this skew distribution biased negatively the positive long-term results on recurrence after mesh repair, providing even stronger evidence for the long-term lower recurrence rate after inguinal hernia mesh repair compared with results after sutured repair. In addition, the fact that old age is a proven risk factor for inguinal hernia recurrence, and that our patients in the sutured group were significantly younger than patients in the mesh group, further supports our main conclusion that mesh repair for inguinal hernia is the more effective method of repair.