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Indian Journal of Surgery, Vol. 66, No. 4, July-August, 2004, pp. 249-250 Letter To Editor Laparoscopic surgery of inguinal hernia in children- Experience with 110 repairs Ramakrishna HK New bridge road, Bhadravathi - 577 301 Code Number:is04065 Sir, This has reference to the article "Laparoscopic surgery of inguinal hernia in children- experience with 110 repairs" by Sanjay Oak et al IJS 2004;66:70-4. The authors have concluded that laparoscopic surgery is BUT COMPARED TO WHAT? Authors have not mentioned the main disadvantage that it makes the surgery transperitoneal which could well be done without entering the abdomen in open surgery. COST EFFECTIVE In the main article author have not given any data on the cost-effectiveness or analysis of the cost of surgery. Neither have they compared laparoscopic repair with open surgery (herniotomy) to show that it is superior to herniotomy. To my knowledge many centers are doing herniotomy as day care procedures. I′ve seen our pediatric herniotomy patients start playing normally within 36 to 48 hours (early return to unrestricted activity referred to above). Operative time -conventional surgery is also done as fast as, probably faster than, laparoscopic repair. Reduction in the period of absence for the parents- Most of our patients are from rural area. Mothers are housewives. So this factor is not significant. Even in the case of both parents employed, they plan it on Saturday so that next day will be holiday. From Monday they can go to their duty normally. Hence, herniotomy can be done with one-day leave or even without a leave. Without referring to any of these things in the main article, it is wrong to conclude "it is cost effective". COSMETICALLY SUPERIOR Inguinal skin crease incision used in the herniotomy is one of best incisions as far as cosmesis is concerned. It is hardly visible after a few months. Also, it covered in the underwear. Compared to this three stab incisions, however small, are in the visible area (if the patient′s habit of dress is so). So, is it appropriate call laparoscopic surgery is cosmetically superior? SAFE In the article itself authors have mentioned 4 recurrences and one hydrocoele. In my 11 years of experience I am yet to see a recurrence or hydrocoele after herniotomy (Either done by me or any other surgeon). Reason may be inexperience. But herniotomy gives good results in the hands of relatively inexperienced surgeons. This implies risk of another surgery (And anesthesia). To say safe it should not only comparable in mortality but also in morbidity. FEASIBILITY IN BILATERAL CASES The only conclusion addressed in the main article. Even here, herniotomy is also feasible. Of course, with two incisions. Copyright 2004 - Indian Journal of Surgery |
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