Erica D Kane, MD, MPH, Marc R Leduc, MD, Nicole F Parentela, BA, Kathryn A Schlosser, MD, Katharine R Bittner, MD, Donna Wilson, MS, John R Romanelli, MD. Baystate Medical Center
Introduction: Peritoneal closure during laparoscopic transabdominal pre-peritoneal (TAPP) inguinal hernia repair has been considered the standard of care to prevent hernia recurrence and bowel obstruction due to mesh adhesion. However, with newer coated meshes, leaving the peritoneal layer open may be a safe alternative, decreasing operative time and post-operative pain. While many studies compare methods of peritoneal closure (PC), no studies report outcomes with no peritoneal closure (NPC). We compare patient outcomes after undergoing PC versus NPC.
Methods: A randomized sample of patients who underwent TAPP between January 2006 and September 2016 at a single institution were included. Patients who had undergone previous major abdominal surgery, same-sided hernia repair, or concurrent abdominal surgery were excluded. Demographic data, comorbidities, and hernia characteristics were collected. Outcomes included operative times, conversion rate, length of stay, resolution of pre-operative symptoms, and complications.
Results: Of 116 patients, 26 underwent PC and 90 underwent NPC. Demographics and comorbidities were comparable. Comparing PC to NPC, 90.0% versus 92.3% were male (p>0.999); mean ages were 48 ± 14 years versus 52 ± 15 years (p=0.24), respectively. In the PC group, 15% patients had bilateral hernias compared to 17% in the NPC group (p=0.59), all others were single-sided. Fifteen-percent of PC group had incarcerated hernias versus 8.6% of NPC; all others were reducible. More PC than NPC patients were asymptomatic pre-operatively (35% versus 12%; p=0.049); conversely, more NPC patient presented with groin pain (62% versus 65%; p=0.02). No NPC patients presented with obstructive symptoms versus 5% of PC.
Mean operative time was 94.21 ± 23.06 minutes in the PC group, compared to 75.04 ± 31.07 minutes in the NPC group. No cases were converted to open.
Average follow-up was 42.6 ± 37.5 months. 81.3% of PC had resolution of pre-operative symptoms compared to 89% of NPC (p=0.60). There was no difference between PC v. NPC in total complications (7.7% v. 10.4%; p=0.52), chronic post-operative pain (11.5% v. 7.0%; p=0.71), recurrence rate (11.5% v. 7.0%; p>0.99), or re-operation for recurrence (3.8 v. 1.7%; p>0.99). There were no bowel obstructions or site infections.
Conclusion: Leaving the peritoneal flap open during TAPP is safe and efficacious. Equivalent patient outcomes were seen across groups after a mean of 3.5 years. Larger study population and further follow-up is necessary to compare true long-term complication rates between PC and NPC.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80540
Program Number: S119
Presentation Session: MIS – Cool Stuff
Presentation Type: Podium