Re: JSLS(2009);13(3):346–349. Long-term Study of Port-site Incisional Hernia After Laparoscopic Procedures

For whatever reason, when the original paper was split into 2 separate papers, Dr. Pelosi's citations went with the second paper. It was my intention that the 2 papers would be published together. However for reasons beyond our control, they were published a few months apart. In the end, our references are correct in the technique paper that Dr. Pelosi refers to. The article is not intended to be a comprehensive review of the literature but serves as a reminder to our fellow gyn colleagues about the value of this technique. I believe that both of these articles validate a topic that Dr. Pelosi has written about in the past. Our article is complementary to Dr. Pelosi's and recognizes his contributions. Now, nearly 4 years after the start of this project, with the increased adoption of robotic surgery, I fear the familiarity of the HALS modality in gynecology may diminish. Although I regret any offense Dr. Pelosi may have taken, I am glad we are able to keep the dialogue going and continue to bring awareness to HALS in our gyn community. We read the article written by Hussain et al 1 with interest. In our recent experience, we have seen 5 epigastric port-site hernias. All procedures were performed by different laparoscopic surgeons. We use 1 of 3 methods in closing 10-mm ports to prevent the formation of port-site hernia. They are sheath tilt, Langenbeck's lift, and Sucker through port techniques. It is universally agreed that the closure of the port site should include approximation of the sheath. We have described the sheath tilt and Langenbeck's lift previously. 2 For epi-gastric port sites, we found the 10-mm sheath tilt requires a slight extension of the skin incision to access the sheath. We use a third method, which we call the " Sucker through port " method. In this method, the sucker for irrigation is inserted to the 10-mm port, and the sheath is pulled out. By tilting the sucker and simultaneously retracting the skin with a medium Lan-genbeck's retractor, one can visualize the sheath clearly. By tilting the sheath on either side, one can take a full-thickness bite of the sheath. Care should be exerted when inserting the suction cannula to ensure that it is not inserted too deeply to avoid damage to intestinal viscera. We always close the 10-mm ports, in particular all epigastric ports, with a 0 PDS …