Laparoscopic inguinal hernia repair
Sir
We read the interesting Review by Messrs Liem and Vroonhoven on laparoscopic inguinal hernia repair (Br J Surg 1996; 83: 1197-204), and agree with the authors that it is premature to advocate a transition from conventional to laparoscopic techniques on a large scale. We were surprised that no comment was made on the risk of mesh infection and pubic osteitis after laparoscopic herniorrhaphy. Several cases of such a complication have been rep~rtedl-~. In theory, infection should not be encountered after a laparoscopic approach for several reasons: the prosthesis introduced through the port has no contact with the skin, it is placed deep and the operation site is away from the port wound'. Laparoscopic experience shows that this is a definite risk and was reported in 0.1 to 0.5 per cent in large series'.2; this is close to the rate reported after conventional prosthetic repair. The mechanism of this complication is unclear; it could be an unrecognized injury of the bladder or the bowel, or even a postoperative haematoma secondarily infected. In the majority of patients the prosthesis had to be removed. As osteitis can be a tragedy for any patient, extra care must be taken when performing laparoscopic hernia repair and patients should be informed about this risk before operation.