Gass, Markus

Guller, Ulrich

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Reply to doi:10.1007/s00464-012-2245-0: Re: Bilateral totalextraperitoneal inguinal hernia repair (TEP) has outcomessimilar to those for unilateral TEP: population-based analysisof prospective data of 6,505 patients. (Surg Endosc. Online First)Markus Gass • Ulrich GullerReceived: 13 February 2012 / Accepted: 28 February 2012 / Published online: 5 April 2012 Springer Science+Business Media, LLC 2012We thank Drs. Koeckerling and Jacobs for their interest inour study. Whether a statistically significant difference is ofclinical relevance often is a matter of great debate. It is afact that one major driver of statistical significance is thesample size: the larger the sample size, the more likely acertain difference between two or several groups willbecome statistically significant [1, 2]. An excellent statis-tical tool in the critical appraisal of the surgical literature isthe number needed to treat, which is in the inverse of theabsolute risk reduction [3]. As outlined in our manuscript[4], the number needed to treat regarding intraoperativecomplications between patients undergoing bilateral versusunilateral total extraperitoneal inguinal hernia repair (TEP)is 83 and for surgical postoperative complications is 111. Inother words, if 83 patients undergo bilateral compared tounilateral TEP, 1 patient will suffer an additional intraop-erative complication. Similarly, if 111 patients undergobilateral instead of unilateral TEP, 1 patient will suffer anadditional surgical postoperative complication. These arelarge numbers to treat, and thus the clinical relevance ofthe observed differences—despite their statistical signifi-cance—is minor [3]. Our findings provide compellingevidence that bilateral TEP represents an excellent optionfor patients with bilateral symptomatic inguinal hernia.Whether an asymptomatic inguinal hernia should beoperated on during a TEP for a symptomatic hernia of thecontralateral side, remains to be elucidated.References1. Guller U, Oertli D (2005) Sample size matters: a guide forsurgeons. World J Surg 29:601–6052. Guller U, DeLong ER (2004) Interpreting statistics in medicalliterature: a vade mecum for surgeons. J Am Coll Surg 198:441–4583. Guller U (2008) Caveats in the interpretation of the surgicalliterature. Br J Surg 95:541–5464. Gass M, Rosella L, Banz V, Candinas D, Guller U (2011) Bilateraltotal extraperitoneal inguinal hernia repair (TEP) has outcomessimilar to those for unilateral TEP: population-based analysis ofprospective data of 6,505 patients. Surg Endosc Nov 24. [Epubahead of print]M. GassDepartment of Visceral Surgery and Medicine, UniversityHospital Berne, Berne, SwitzerlandU. Guller (&)Department of Visceral Surgery and Medicine, University ofBerne, Berne, Switzerlande-mail: ulrich.guller@gmail.com123Surg Endosc (2012) 26:2700DOI 10.1007/s00464-012-2246-zand Other Interventional Techniques 

Reply to doi:10.1007/s00464-012-2245-0: Re: Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients. (Surg Endosc. Online First)

http://doc.rero.ch/record/314167/files/464_2012_Article_2246.pdf

Reply to doi:10.1007/s00464-012-2245-0: Re: Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients. (Surg Endosc. Online First)

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