Laparoscopic Hernioplasty-Reply

In Reply.—Lichtenstein et al state that modern day hernioplasty is efficacious and simple, but recent reviews of hernia repairs show recurrence rates as high as 20.9%.¹ The absence of recurrences in 1000 cases reported by Lichtenstein et al² has been the exception and must be attributed to the "tension free" repair. Proponents of laparoscopic herniorrhaphy use this principle to reduce recurrence. Concerns over long-term fate of intraperitoneal prosthetic material is real and formation of adhesions, erosion into adjacent structures, and infection must be a concern for any surgeon using these materials in the peritoneal cavity. The ultimate prosthetic material for intraperitoneal placement has not been developed, and surgeons should only implant these materials after careful consideration and informed consent. Another technique that may alleviate the need for intraperitoneal placement is the preperitoneal repair with prosthetic mesh. Open surgical repair using Stoppa's technique of preperitoneal prosthetic mesh placement