EDITOR—Our paper on hernia repair produced much correspondence1 2.In response to the letter from Notaras we agree that patients unfit for general anaesthetic, and therefore not suitable for laparoscopic repair, would be suitable for local anaesthetic, and this is how we would treat them. We do not agree that the reduced pain after laparoscopic repair, the improved quality of life, and the faster return to work and other activities are unimportant to the patient. Our view that these constitute important improvements from the patients' perspective is borne out by our table showing patient satisfaction (table 6).

Rose et al point out the absence of serious complications in …