Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty

Excerpt

I read with interest the article by Lau et al [1] in the October issue of Surgical Endoscopy. I disagree with their contention that peritoneal tears during TEP inguinal hernia repair require closure. We began doing TEP hernia repairs in 1992, taught the first dedicated course to teach the repair in 1993, and published the first large series of 365 repairs using balloon dissection in 1995 [2]. During this time, we developed and taught to all surgeons the idea of simply placing a Veress needle into the peritoneal cavity if a tear in the peritoneum occurred. This allows for decompression of the peritoneal cavity and the TEP can be readily completed. The important point is to keep the Veress needle in the abdominal cavity until the end of the repair and evacuate all CO₂. The tear is a gaping hole only if the peritoneal cavity is distended with gas. After all of the CO₂ is evacuated, the edges of the tear come in apposition and seal. In more than 2000 TEP repairs done by us, we have handled any tear in the peritoneum in this fashion. We have never closed any tear and have never had any adverse sequelae, such as bowel obstructions. …