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To the Editor: Dr Fitzgibbons and colleagues¹ compared watchful waiting with the surgical repair of minimally symptomatic inguinal hernia in men. However, they did not indicate how the outcomes may have differed between patients with direct and indirect inguinal hernias. The anatomy of the inguinal canal is important in this regard. Indirect inguinal hernias present through the internal inguinal ring and carry a significant risk of incarceration and/or strangulation. Direct inguinal hernias present through the floor of the inguinal canal and carry considerably less risk of complications.²

Even the putative mechanism for the development of these 2 types of inguinal hernias is different. The indirect type often occurs in young men and may be congenital in origin. The direct type tends to occur in older men and is caused by progressive weakening of the tissue structures.² It would therefore be valuable to know if the results of this trial differed . . . [Full Text of this Article]

Gardner W. Smith, MD
gwsmith@direcway.com
Deer Isle, Me

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