Spreadsheet: 139497d1328276113-excel-2007-copy-data-from-cells-in-one-workbook-to-another-based-on-the-cell-headings-sampleforload
Sheet: SURG

Author | Affiliation | Title | Comment | Disclosure | commentStatusID | datePublished | publishingUserID | volume | issue | page | dateSubmitted | siteID | userID | creationDate | updateDate
[NAME],  MD  Chairman [NAME] Surgery Nassau University Medical Center |  |  | What a delight to see someone publish what so many of us have believed for over 50 years. It's great to have known you. [NAME]: None declared |  | NR |  |  | 146 | 5 | 528
[NAME],  [NAME] MSc MRCS  Royal Gwent Hospital,  [NAME] |  |  | Sir,   Although someone once said 'if you torture the data long enough, you can make it say anything' we believe that the Swedish Hernia Registry (SHR) may not have done themselves justice, in that we think further information is required before it can be concluded that short-term absorbable sutures are a risk factor for hernia recurrence (1).   The SHR present data on an impressive number of hernia repairs, however essential facts concerning the time to recurrence is missing and the misleading assumption that any kind of hernia in a groin in which a hernia has previously been repaired equated to a recurrence has been made. Whilst the authors admit this could be misconstrued it is a valid supposition and has been previously 'agreed' at least in principle in other registry data. However if the SHR are to conclude that recurrence is related to short-term absorbable sutures then they need to demonstrate a temporal relationship between suture type and subsequent recurrence. In addition, having collected so much data, can they tell us all whether the recurrence operated on was indeed a recurrence of the hernial defect (direct or not). These points are clearly vital to their conclusions or have we not fully absorbed their message?   Yours faihfully   [NAME] MRCS [NAME], FRCS   (1) More Recurrences After Hernia Mesh Fixation With Short-term [NAME]. Novik B, Nordin P, Skullman S, Dalenback J, [NAME] of Surgery. 2011; 146 (1): 112-17.    Conflict of Interest: None declared |  | P |  |  | 146 | 1 | 12
[NAME],  MD  CLINTEC, Karolinska Institute,  [NAME], [NAME], [NAME], [NAME] |  |  | We appreciate the comments from Drs. [NAME] and [NAME] and welcome the opportunity to clarify some issues regarding the validity of our study[1], as we disagree with their objections. On the contrary, our study validly and clearly has shown that short-term absorbable sutures for the mesh fixation are an independent risk factor for recurrence following the Lichtenstein inguinal hernia mesh repair. At least as interesting was the finding that long-term absorbable sutures do not raise the recurrence risk, as compared to standard nonabsorbable sutures.   Beaton and [NAME] question the appropriateness of the definition of recurrence in the Swedish Hernia Registry (SHR) and argue that our study lacked essential information regarding time to, and type of, recurrence. However, we believe that their objections to our article rather reflects a still common, but somewhat outdated view on hernia surgery.   A hernia indicates a possible (inherited or acquired) connective tissue disorder[2-7], sometimes called “herniosis”[8]. Therefore, modern hernia surgery aims not just to repair a hole, but also to reinforce the surrounding tissue in order to prevent both recurrent and “new” hernias[9]. From the patient’s perspective, it is irrelevant whether a need for a another operation, an undesired event, is caused by a “true” recurrent or a “new” hernia. Therefore, from its inception the SHR has defined all subsequent hernia repairs in the same groin as recurrent.   In the Comment section, we elaborated (270 words) on the complexity and impracticability in a large study to define and determine the exact date for a recurrence[1]. Our study investigated the relative risks of recurrence depending on mesh fixation material, not the reason for recurrence in each individual case. In our article, we therefore avoided to speculate about possible mechanisms behind recurrence due to short-term absorbable sutures, but of course we have theories. Mesh fixation is insufficient if it does not keep the mesh in place properly, until adequate mesh-tissue integration has been obtained. Mesh migration, folding and wrinkling can commonly be detected in hernia reoperations. Eg, if the first operation repaired an indirect hernia, a rolled up “meshoma”[10] will not prevent neither an indirect “recurrence” or a direct “new” hernia. When a mesh is not adequately incorporated where it was supposed to, is there a maximum time span for that to cause a recurrence or new hernia?   We are all individuals. Our biologic responses to different synthetic mesh and suture materials vary. Some people may not need any mesh fixation at all, for many others short-term absorbables will suffice, but for some of us nonabsorbable or long-term absorbable mesh fixation is necessary.   [NAME] (corresponding author), [NAME], [NAME], [NAME], [NAME]   REFERENCES   1. Novik B, Nordin P, Skullman S, [NAME], [NAME] More recurrences after hernia mesh fixation with short-term absorbable sutures: A registry study of 82 015 Lichtenstein repairs. [NAME]. 2011;146(1):12 -17.   2. [NAME], [NAME]. Hernias as a collagen maturation defect. [NAME]. 1964;160(5):852-859.   3. [NAME] The unified theory of hernia formation. Hernia. Aug 2004;8(3):171-176.   4. Read RC. Inguinal herniation in the adult, defect or disease: a surgeon's odyssey. Hernia. Dec 2004;8(4):296-299.   5. [NAME], [NAME], [NAME] The biology of hernia formation. Surgery. Jul 2004;136(1):1-4.   6. [NAME]. The biology of hernias and the abdominal wall. Hernia. Dec 2006;10(6):462-471.   7. [NAME], Yadete DH, [NAME], [NAME], [NAME] LN. Connective tissue alteration in abdominal wall hernia. [NAME]. Feb 2011;98(2):210-219.   8. Klinge U, [NAME], Mertens PR. Herniosis: a biological approach. Hernia. Dec 2004;8(4):300-301.   9. Read RC. Milestones in the history of hernia surgery: prosthetic repair. Hernia. Feb 2004;8(1):8-14.   10. Amid PK. Radiologic images of meshoma: a new phenomenon causing chronic pain after prosthetic repair of abdominal wall hernias. [NAME]. Dec 2004;139(12):1297-1298.    Conflict of Interest: None declared |  | P |  |  | 146 | 1 | 12
[NAME],  MD  Wright State Department of Surgery |  |  | Dear Dr. [NAME] and colleagues,   In your article comparing methylene blue versus isosulfan blue dye with respect to injection site mass, you reported a statistically significant drop in pulse oximetry readings in those patients who received isosulfan blue dye.   However, I noticed that said group of patients had many more non- Hispanic white individuals and fewer Hispanics than the group that received methylene blue. Is it possible that pulse oximetry in fair(er) skinned individuals is more likely to detect false variations in SpO2 due to a vital dye than in darker skinned individuals? You had fewer non- Hispanic whites, more Hispanics, and more blacks in your methylene blue group and thus I pause to wonder if the distribution of ethnicities in this study has swayed the results towards a false conclusion. Your thoughts?   [NAME], MD Wright State University, Department of Surgery 1 Wyoming Street Dayton, OH 45409    Conflict of Interest: None declared |  | P |  |  | 146 | 2 | 137