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Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh

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Abstract

Background

Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure.

Methods

A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence.

Results

Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p = 0.01), current smoking status (p = 0.05) and hernia side [p = 0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1 ± 37.1 min vs. 76.8 ± 32.9, p < 0.0001). No cases were converted to open. Average follow-up was 21.6 ± 23.8 months. Ninety-three percent of closure patients had documented resolution of pre-operative pain versus 94.0% of non-closure (p = 0.81). The closure group experienced a higher percentage of post-operative complications, though this did not reach significance (5.5 vs. 2.3%; p = 0.36). Compared to the closure group, the non-closure groups experienced similar post-operative pain (3.6 vs. 1.2%; p = 0.24) and recurrence rate (1.8 vs. 4.0%; p = 0.68). There were no bowel obstructions, surgical site infections, unplanned readmissions, or unplanned re-operations.

Conclusions

Equivalent patient outcomes were seen for both procedure types post-operatively and during follow-up. Operative times were significantly shorter for non-closure patients. Larger study population and longer follow-up is necessary to evaluate true long-term complication rates in flap non-closure.

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Abbreviations

TAPP:

Trans-abdominal preperitoneal

TEP:

Total extra peritoneal

SBO:

Small bowel obstruction

IEHS:

International Endohernia Society

EHS:

European Hernia Society

EAES:

European Association for Endoscopic Surgery

SAGES:

Society of American Gastrointestinal and Endoscopic Surgeons

RCT:

Randomized controlled trial

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Funding

No funding, internal support, or external supposed was received for this study.

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Authors and Affiliations

  1. Department of Surgery, University of Massachusetts Medical School-Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA

    Erica D. Kane, Marc Leduc, Kathryn Schlosser & John R. Romanelli

  2. Academic Affairs: Office of Research, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, USA

    Nicole Parentela

  3. Academic Affairs: Epidemiology/Biostatistics Research Core, University of Massachusetts Medical School-Baystate Medical Center, Springfield, MA, USA

    Donna Wilson

Authors
  1. Erica D. Kane
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  2. Marc Leduc
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  3. Kathryn Schlosser
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  4. Nicole Parentela
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  5. Donna Wilson
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Correspondence to Erica D. Kane.

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Disclosures

John Romanelli is a consultant for Covidien but no funding or support was received for this work. Erica Kane, Marc Leduc, Kathryn Schlosser, Ms. Nicole Parentela, and Ms. Donna Wilson have no conflicts of interest or financial ties to disclose.

Additional information

The data collection for this study was initiated in September 2016; no data was collected longer than 3 years ago.

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Kane, E.D., Leduc, M., Schlosser, K. et al. Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh. Surg Endosc 32, 627–637 (2018). https://doi.org/10.1007/s00464-017-5712-9

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