Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique
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Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique K. G. Mathew1 · G. Pokhrel1 Received: 1 April 2020 / Accepted: 25 May 2020 © Springer-Verlag France SAS, part of Springer Nature 2020
Abstract Purpose Peritoneal tears occurring during TAPP and TEP are common, and can cause difficulty in continuing surgery, or, if left open can cause postoperative complications. A number of techniques to close the tear in the peritoneum have been described. These techniques are difficult and add to the operating time, and may not be successful in closing the opening in the peritoneum. We describe a simple, effective, fast technique of repairing these tears using the bipolar diathermy. Method We have used bipolar diathermy to seal inadvertent peritoneal tears occurring during TAPP/TEP repairs. This method of sealing the peritoneum has been used by us since 2015. We decided to review our results of sealing the tears in the peritoneum at TAPP/TEP from 01 Jan 2017 to 31 Dec 2019. Results A total of 152 laparoscopic inguinal hernia repair (TAPP/TEP) procedures were done by the authors from 01 January 2017 to 31 December 2019, and of these, 101 cases had some degree of peritoneal tear. All peritoneal tears were very simply sealed using bipolar diathermy. Conclusions Peritoneal tears occurring inadvertently during Laparoscopic TAPP/TEP procedure for repair inguinal hernia can be effectively sealed with simple bipolar diathermy Keyword Peritoneal tear sealing technique · Bipolar sealing · Laparoscopic · TAPP · TEP
Introduction Peritoneal tears occur during both TEP and TAPP. However, tears that occur during TEP have received more attention, as these have the potential to increase the operative difficulty/ increase operation time/may even necessitate conversion to TAPP or open procedure. Tears do occur also at TAPP, but this does not significantly interfere with the procedure. However, these tears of the peritoneum at TAPP are important, as, if not closed at the end of the procedure, have the potential to cause postoperative complications like bowel obstruction due to migration of bowel through this tear/ bowel adhesion to exposed mesh [5]. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10029-020-02237-z) contains supplementary material, which is available to authorized users. * K. G. Mathew [email protected] 1
NMC Specialty Hospital, Al Nahda 2, Dubai, United Arab Emirates
The incidence of peritoneal tears at TEP is reported from 10.9 to 47%, and 13% of the peritoneal tears at TEP are large enough to need closure and account for conversion to TAPP or open repair [1] [2]. Interestingly, there are no reports of the incidence of peritoneal tears at TAPP, probably as these do not interfere with the surgery. However, it is recommended that the larger tears be closed at end of the procedure. The techniques described to close peritoneal tears at TAPP or TEP are: suture closure, endoloop [2], endostapler [2], and hemolok cl
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