Indian Journal of Surgery Medknow Publications on behalf of Association of Surgeons of India ISSN: 0972-2068 Vol. 66, Num. 5, 2004, pp. 304-304

Indian Journal of Surgery, Vol. 66, No. 5, September-October, 2004, pp. 304

Letter To Editor

Skin staples for securing the mesh in tension free inguinal hernia repair: Should we abandon conventional suture?

Gomez-Leon JoseF

Department of Surgery, Hospital Universitario, Dr. Luis Razetti, Barcelona, Anzoategui
Correspondence Address:Department of Surgery, Hospital Universitario, Dr. Luis Razetti, Barcelona, Anzoategui jfgldoc@hotmail.com

Code Number: is04082

Sir,

In a recent published article named Comparative study of skin staples and polypropylene sutures for securing the mesh in lichtenstein′s tension free inguinal hernia repair: A Prospective randomized controlled clinical trial, the authors advocate the use of a skin stapler device in order to decrease operative time in placing the mesh and promote further investigation to explore the impact of reduced operative time on post-operative complications and recurrence rate. In their series they report a complication rate of 39.9% in the staplers group and 42.9% in the polypropylene group. If postoperative complications are to be accepted as primary outcome when comparing this two different techniques we could assume that no difference are achieved in spite of reduced time of operation with the staplers device. Analyses of the results given allow calculating some numbers that must be considered when deciding which procedure assume. Number Needed to Treat (NNT) for 1 patient can be free of postoperative complication using staples instead of polypropylene is 30 (95% confidence interval 4 to infinity); Relative Risk (RR) of 0.92 tends to favor Staplers use, but confidence intervals are no significant (0.51 to 1.58). As the authors state, the increased cost of consumables per operation is increased when both mesh and staples are used, and, if no considerable difference in terms of risk reduction of postoperative complications are achieved I consider that traditional use of suture for fixing the mesh should not be abandoned in terms of improving operative time.

Copyright 2004 - Indian Journal of Surgery