Unsuspected femoral hernia in patients with a preoperative diagnosis of a recurrent inguinal hernia, author reply

Abstract

We would like to thank Dr. R. Bendavid for the thoroughcomment on our paper ‘Unsuspected femoral hernia inpatients with a preoperative diagnosis of recurrent inguinalhernia’. However, we are afraid that Dr. R. Bendavid mayhave missed the aim of the study from which we quote:‘The aim of this study was to examine the incidence ofunsuspected femoral hernia discovered at transabdominalpreperitoneal (TAPP) laparoscopic inguinal hernia repairin two well-defined groups: (1) patients with bilateralprimary inguinal hernia and (2) patients with recurrentinguinal hernia’. When the aim is to examine unsuspectedfemoral hernias, it would be paradoxical to include patientswith a preoperative diagnosis of a femoral hernia.Dr. R. Bendavid prefers to mention his series of 508 openfemoral hernia repairs [1, 2], which is of course notewor-thy; however, it does not cover unsuspected femoral her-nias and is therefore not within the subject of our article.Dr. R. Bendavid claims that the article is in favour oflaparoscopic hernia surgery. In fact, the majority ofinguinal hernia repairs are performed by open approach inour department. Firstly, referring to the aim of the studyagain, we examined unsuspected femoral hernias inpatients undergoing laparoscopic hernia repair. Secondly,we do believe that laparoscopic approach is preferable inselected cases such as bilateral primary inguinal hernias,recurrent inguinal hernias after Lichtenstein repair andgroin hernias in women. This selection is based on theguidelines of the European Hernia Society (EHS) [3] andnot on our own personal experience. However, we notedthat Dr. R. Bendavid does not agree with the EHS guide-lines on several points including the definition of a femoralhernia.Furthermore, we have been misunderstood byDr. R. Bendavid and must clarify that we do not operate onpatients with asymptomatic inguinal hernias. Finally,Dr. R. Bendavid has cited us incorrectly. We have stated inour paper that we do not find the Lichtenstein repair to beherniogenic.References