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Abstract
Background: There has not been an absolute consensus over the routine closure of peritoneal defect (PD) during laparoscopic totally extraperitoneal inguinal hernia repair (TEP). Pretied sutures, endoscopic stapling, and suturing are surgical techniques for closing PDs. Moreover, we observed that we could close small PDs during the TEP procedure by sealing with the LigaSure (LS).
Objectives: The present study aimed to evaluate the necessity of closure PDs under a polypropylene mesh and the early intraperitoneal inflammatory, fibrotic, and adhesional effects of sealing PDs with the LS in an experimental rat model.
Methods: A total of 35 male rats were assigned to five groups. 1- Control group: mesh was not used, and the peritoneum was left open; 2- Mesh group; mesh was placed directly on the PD without repairing, and three peritoneal repairing methods; 3- Stapling group: PD was repaired with metal clips; 4- Suture group: PD was repaired with Vicryl sutures; and 5- LigaSure group: PD was closed with the LS. Rats were sacrificed on the postoperative 14th day. Adhesion scores, fibrosis, and inflammation scores were compared between all groups.
Results: All rats completed the 14 days of follow-up without complication. The Mesh group had significantly higher adhesion scores than the other groups (P<0.001). Nonetheless, no significant difference was observed between peritoneal repairing methods (P=0.696). Fibrosis and inflammatory scores were similar in peritoneal repairing methods (P=0.394 and P=0.112, respectively).
Conclusion: The direct contact of foreign bodies with the intra-abdominal organs increases the risk of adhesion; therefore, the remaining PDs under the polypropylene mesh should be repaired. Sealing PDFs with LS is a simple method that does not increase the inflammatory response, fibrosis, and the risk of adhesion formation.
References
Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc. 2011;25(9):2773–843. doi: 10.1007/s00464-011-1799-6. [PubMed: 21751060].
Shpitz B, Lansberg L, Bugayev N, Tiomkin V, Klein E. Should peritoneal tears be routinely closed during laparoscopic total extraperitoneal repair of inguinal hernias? a reappraisal. Surg Endosc Other Interv Tech. 2004;18(12):1771–3. doi: 10.1007/s00464-004-9001-z. [PubMed: 15809787].
Ng WT. Should peritoneal tears be routinely closed during total extraperitoneal repair of inguinal hernias? Surg Endosc. 2006;20(12):1928–9. doi: 10.1007/s00464-005-0077-x. [PubMed: 17063292].
Lau H, Patil NG, Yuen WK, Lee F. Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc. 2002;16(10):1474–7. doi: 10.1007/s00464-001-8299-z. [PubMed: 12072988].
Cassar Delia E, Gurusamy KS, Davidson BR. Peritoneal closure versus no peritoneal closure for decreasing wound complications after non-obstetric abdominal operations. Cochrane Database Syst Rev. 2013;2013(3):CD010424. doi: 10.1002/14651858.CD010424.pub2. [PubMed: 23828487].
World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191-4. doi: 10.1001/jama.2013.281053. [PubMed: 24141714].
National Research Council (US) Committee for the update of the guide for the care and use of laboratory animals. guide for the care and use of laboratory animals. 8th ed. Washington (DC): National Academies Press (US); 2011. Doi; 10.17226/12910. [PubMed: 21595115].
Sikkink CJ, de Reilingh TS, Malyar AW, Jansen JA, Bleichrodt RP, van Goor H. Adhesion formation and reherniation differ between meshes used for abdominal wall reconstruction. Hernia. 2006;10(3):218–22. doi: 10.1007/s10029-006-0065-7. [PubMed: 16482401].
Voeller GR, Lau H. Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc Other Interv Tech. 2003;17(8):1335–6.
Ng J, Cheng D. Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc Other Interv Tech. 2003;17(10):1683.
Janssen PF, Brölmann HA, Huirne JA. Effectiveness of electrothermal bipolar vessel-sealing devices versus other electrothermal and ultrasonic devices for abdominal surgical hemostasis: A systematic review. Surg Endosc. 2012;26(10):2892–901. doi: 10.1007/s00464-012-2276-6. [PubMed: 22538684].
Okmen H, Ulusan K. A Simple Technique to close peritoneal tears in laparoscopic totally extraperitoneal hernioplasty: extracorporeal peritoneal Knotting. Istanbul Med J. 2021;22(2):140–3. doi: 10.4274/imj.galenos.2021.62343.
Mathew KG, Pokhrel G. Closing peritoneal tear during laparoscopic inguinal hernia repair: simple and effective technique. Hernia. 2020;24(5):1121–4. doi: 10.1007/s10029-020-02237-z. [PubMed: 32500166].
Kapur ML, Daneswar A, Chopra P. Evaluation of peritoneal closure at laparotomy. Am J Surg. 1979;137(5):650–2. doi: 10.1016/0002-9610(79)90040-0. [PubMed: 453458].
DiZerega GS, Campeau JD. Peritoneal repair and post-surgical adhesion formation. Hum Reprod Update. 2001;7(6):547–55. doi: 10.1093/humupd/7.6.547. [PubMed: 11727863].
Tsai JM, Sinha R, Seita J, Fernhoff N, Christ S, Koopmans T, et al. Surgical adhesions in mice are derived from mesothelial cells and can be targeted by antibodies against mesothelial markers. Sci Transl Med. 2018;10(469). doi: 10.1126/scitranslmed.aan6735. [PubMed: 30487249].
Gossetti F, D’Amore L, Annesi E, Bruzzone P, Bambi L, Grimaldi MR, et al. Mesh-related visceral complications following inguinal hernia repair: an emerging topic. Hernia. 2019;23(4):699–708. doi: 10.1007/s10029-019-01905-z. [PubMed: 30796629].