The gold-standard technique for inguinal hernia repair is the open approach
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LETTER TO THE EDITOR
The gold‑standard technique for inguinal hernia repair is the open approach S. Huerta1 Received: 25 May 2019 / Accepted: 20 June 2019 © Springer-Verlag France SAS, part of Springer Nature 2019
In the manuscript, “A direct comparison of robotic and laparoscopic hernia repair: patient-reported outcomes and cost analysis” by Zayan et al. [1], is the reader to assume that the gold-standard operation for inguinal hernia repair is the laparoscopic approach? The authors examined both ventral and inguinal hernias in their analysis. The focus of my discussion centers around inguinal hernias, and ventral hernias are the subject of a different argument. The authors are to be congratulated in assessing patient-reported outcomes for hernia repairs with well-standardized tools as well as conducting adequate follow-up for up to 1 year by phone interviews in all arms of the study. However, the authors compared the robotic approach to the laparoscopic technique for the repair for inguinal hernias. If this was a comparison assessing cholecystectomies, a valid comparison can be established for a new technique because the gold-standard operation to cholecystectomy is laparoscopy. This is not the case for inguinal hernias. In fact, the strongest evidence continues to show a superiority of the open technique compared to laparoscopy for inguinal hernia repair [2, 3]. We believe that the best technique to an inguinal hernia repair rests on the expertise of the surgeon. However, centers with high-volume laparoscopy might have equivalent outcomes in laparoscopic inguinal hernia repair compared to the open approach. But these centers are limited in western countries. We have analyzed our experience with open, laparoscopic, and robotic techniques each performed by an expert in only one approach. In our analysis, the open technique remained superior in all measured outcomes including recurrence and inguinodynia [3]. Thus, we find that if the aim This comment refers to the article available at https://doi. org/10.1007/s10029-019-01943-7. * S. Huerta [email protected] 1
Department of Surgery, VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX 75316, USA
of the authors in Zayan et al. study was to assess overall outcomes, satisfaction, and cost of either the laparoscopic, or robotic approach, an open arm should have been included. Of the one million inguinal hernias performed in the United States, this constitutes 5% of inguinal hernias performed around the world. Therefore, a small fraction of inguinal hernias is performed around the world that have laparoscopic and robotic capabilities. In fact, in Guatemala even elective cholecystectomies are currently performed via the open approach because laparoscopy is limited [4, 5]. Comparisons of surgical outcomes and cost should include a gold standard, which today for inguinal hernias is the open approach.
Compliance with ethical standards Conflict of interest None of the authors have any interests to disclosed. Ethical approval This study is
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