Re: JSLS(2009)13:302–305. Improved Outcomes for Lap-banding Using the Insuflow Device Compared with Heated-only Gas

2. Durai R, Ng PC. Novel methods of closing 10-mm laparo-scopic port-site wounds. Dear Colleagues: Many thanks for your interest in our article. We should congratulate you for your excellent results that you " have not come across a single case of port-site incisional hernia even after several years of surgical practice. " Having said that, you are closing the 10-mm port using 3 different techniques (sheath tilt, Langenbeck's lift, and Sucker through port techniques). It would be interesting to know what type of/and how many operations you have done, and also how many obese patients and how many children were included. The major inherent weakness of reporting on the hernia issue is the follow-up. The longer the follow-up the higher would be the incidence of hernias. Studies from respected centers in the world have confirmed this. 1 The other issue is that sometimes surgeons do not see their complications, because their patients present to other colleagues. We too have operated on patients who underwent surgery somewhere else, and also you mentioned that you operated on several patients who were operated on by other surgeons. On top of that is the iceberg phenomenon, as we may not see patients with subclinical hernia (especially in the obese), because they are not symptomatic or they are not seeking medical help. The last issue is the controversy in reporting cross-sectional imaging of patients who presentwith symptoms suggestive of port-site hernia. It is mandatory to close the 10-mm port. We also close 5-mm ports in kids. A recent study 2 had a confirmed incidence of 3.2% of port-site hernias in children who underwent laparoscopic procedures. Needless to say, 5-mm ports can be potential hernia sites, especially in elderly frail patients and thin and malnourished patients. We totally agree with you that refining the closure techniques or invention of new methods is crucial to reducing the catastrophic accidents of port-site incisional hernia. 3 CC. Long-term follow-up of technical outcomes for incisional hernia repair. JL. Hernia at 5-mm laparoscopic port site presenting as early postoperative small bowel obstruction. We read with interest the recent paper by Benavides et al 1 and commend the authors for conducting a double-blinded, randomized trial of this nature. There are very few high-quality trials evaluating warming and humidifi-cation of laparoscopic insufflation gas. 2,3 The authors indicate that the surgeon and principal investigator were blinded to patient allocation. However, the method of …