To the Editor.—I read with interest the article by Rubin et al1 that appeared in the March issue of the Archives.
As someone who does a reasonable number of inguinal hernia repairs in patients in the population group described in the article, I am always concerned about appropriate preoperative evaluation.
I was disturbed by this article for several reasons. The title includes "Flexible Sigmoidoscopy," yet what the authors described was a colonoscopic procedure using 133- or 173-cm endoscopes. Clearly, that is not a flexible sigmoidoscopic evaluation.
In addition, I am disturbed by the large number of patients in whom only the middle sigmoid colon was reached on examination. The authors indicated that they were able to get only this far in 11% of the patients. They did not indicate whether this was secondary to problems with preparation or whether they were unable to negotiate further than this because