Numbers speak louder and communicate a clearer message than words: author's reply
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LETTER TO THE EDITOR
Numbers speak louder and communicate a clearer message than words: author’s reply P. Gavriilidis1 · R. J. Davies2 · J. Wheeler2 · N. de’Angelis3 · S. Di Saverio2 Received: 23 December 2019 / Accepted: 5 January 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Dear Editor, We are indeed grateful to F. Köckerling and D. Adolf for their interest [1] in our study on total extraperitoneal endoscopic hernioplasty versus Lichtenstein hernioplasty which for the first time assesses the evolution of evidence over time using updated traditional and cumulative meta-analysis [2]. In particular, cumulative meta-analysis can be used to detect positive or negative effects every time a new study is added, and is able to demonstrate turning points and hidden significance when compared to traditional meta-analysis [3, 4]. A hallmark paper on the power of cumulative meta-analysis was published by Lau et al. and demonstrated that the use of streptokinase as thrombolytic therapy for myocardial infarction was postponed for routine use for at least 15 years, because the results of the updated traditional meta-analysis were inconclusive. However, the cumulative meta-analysis in contrast to the traditional updated version demonstrated underlying significance; had this comparison been taken into account earlier then perhaps more patients could have benefited [3, 4]. First, regarding the evolution of evidence of the recurrence rate, the authors rightly state that all previous metaanalyses and the present one demonstrate significantly higher recurrence rates for the TEP hernioplasty [5–8]. Moreover, they accept that the method used was correct. However, they do not take into account that this study is not a simple
* S. Di Saverio [email protected] 1
Division of Gastrointestinal and Hepato‑Biliary‑Pancreatic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London W12 0HS, UK
2
Cambridge Colorectal Unit, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK
3
Department of Digestive Surgery, Henri Mondor University Hospital, 94010 Créteil, France
updated meta-analysis. In this study, for the first time, we combine updated traditional with cumulative meta-analysis which is the most appropriate method to detect influential studies and turning points in evidence over time [3, 4]. Based on the results of the cumulative meta-analysis, the study by Neumayer et al. is not a single study that demonstrates significantly higher recurrence rates for the TEP hernioplasty compared to Lichtenstein, but it is the first study that pinpoints the turning point of demonstrating that the Lichtenstein procedure has a significantly lower recurrence rate. Of note, from 2004 until now, the evidence from ten studies demonstrates statistically significant lower rates of recurrences in favour of Lichtenstein, although the updated traditional analysis demonstrates non-significant differences [Fig. 1]. Our main aim was to present the results
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