Is Peritoneal Closure Required in Tep Procedure

Bojan m Radovanovic, md, Miodrag m Cudomirovic, md, Nenad m Davidovic, md. General hospital Pozarevac


In the literature and in guidelines (IEHS), closure of peritoneum is recommended in laparoscopic TEP procedure. Most of papers about postoperative ileus, caused by unclosed peritoneum, are case reports.
Material and method
In last seven years we operated 652 patients with TEP technique. 23 % were bilateral hernias. All operations were performed by three surgeons, with same technique. The age of patients was between 19 and 78 years. Operation technique were standard with two working 5 mm trocars, one in midline and one lateral. One or two meshes 10 x 15 cm were used. In some cases (only big direct hernias) we fixed them with tucker or glue. We had small opening of peritoneum in 80% of cases. There were big opening ( 2 cm or more) in 35% of them.
We never closed peritoneum besides dimension of peritoneal gap. During exsufflation of gas we hold the peritoneum edge and approximate defect. Among all other complications we don’t have any case of postoperative ileus. The average follow up of the patients are two and the half years.
This is a small number of patients, but it seems that if we pay attention et the end of operation we can avoid suturing of peritoneum, which is time consuming. After the exsufflation of gas there is no possibility of bowel interposition. But there is still a chance of the late ileus caused by adhesion between uncovered mesh and bowel.

Session Number: Poster – Poster Presentations
Program Number: P306
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