EDITOR,—Kate Lawrence and colleagues conclude that more complications occur after laparoscopic than after open repair of inguinal hernias and that costs are higher.1 There are, however, several flaws in their study.

At the start of the study the most experienced laparoscopic surgeon had performed only 20 repairs and the others had performed fewer, though the number is not stated. It is questionable whether comparing the laparoscopic repairs of surgeons on the steep part of the learning curve (which would include the surgeon who had …