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What is a clinically relevant difference in recurrence rate in groin hernia repair when performed by experts? A 0% recurrence rate is no doubt an excellent result. But how about 3%? It is good, but is it excellent? Is the difference clinically relevant?

I congratulate the authors of the article on fixation vs nonfixation of mesh in laparoscopic total extraperitoneal inguinal hernioplasty, published in the December issue.¹ It is the first published randomized trial on an important and controversial technical detail in this operation. Adding to the ongoing global discussion on whether to fixate the mesh, the study contains clinically relevant outcome variables such as recurrence rate and chronic pain and costs associated with staples.

The authors claimed that mesh nonfixation yields an unaltered recurrence rate and costs 400 ($500) less, ie, the null hypothesis was confirmed. They also suggested that mesh fixation only has an advantage in direct bilateral . . . [Full Text of this Article]

AUTHOR INFORMATION
Bengt Novik, MD

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