Should peritoneal tears be routinely closed during total extraperitoneal repair of inguinal hernias?

Excerpt

I was highly gratified to read Shpitz et al.’s [10] article reporting no complications attributable to unclosed peritoneal tears following total extraperitoneal hernia repair at a mean follow-up of 16 months among their 40 patients. This well-conducted study calls into question the need for routine closure of peritoneal tears, and it serves to vindicate our treatment strategy recently published [8], which has been criticized as “adding fuel to the fire” [5]. Referencing the literature about the management of peritoneal tears, the authors were surprised to find very few publications (apparently only two articles [6, 11], with diametrically opposite views) addressing specifically this rather common problem. It is not surprising that they do not include our article in their review because it was published only very recently. In our article [8], we suggest that for selected difficult cases with collapsing preperitoneal space due to valvular effect, a possible option is to make a small hole higher up in the peritoneum to equalize the pressure, thereby allowing the freed peritoneal layer to drop down and open up the working space. After the placement of the mesh, all small peritoneal defects were not routinely closed. Similar to their experience, none of our patients have developed adhesive bowel obstruction during a follow-up period of 7 years. …