Page 10 - World Journal of Laparoscopic Surgery

WJOLS

Ahmed E Lasheen et al 10.5005/jp-journals-10033-1273
OriginaL articLe

Percutaneous Transabdominal External Looped Needle

for Peritoneal Closure in Laparoscopic Transabdominal
Preperitoneal Inguinal Hernia Repair

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1 Ahmed E Lasheen, AbdelRhman Sarhan, Ayman Salem, Tark Shiref
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ABSTRACT approach have become the most commonly used ap-
Introduction: Transabdominal preperitoneal (TAPP) hernio- proaches. Transabdominal preperitoneal is an approved
plasty is a common procedure for groin hernia repair. The and common surgical procedure for groin hernia repair
peritoneal closure after mesh placement is recommended to in adults, especially for bilateral and recurrent inguinal
avoid mesh exposure to the viscera with the risk of adhesions hernias after open repairs. The procedure is performed
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and bowel incarceration into peritoneal defects. This study of-
fers a novel technique for peritoneal closure by using external by dissection of the preperitoneal space and a mesh
looped needle. repairs the hernia defect. The closure of the peritoneum
Materials and methods: During the period from April 2013 after mesh placement must be performed uninterrupted
through August 2015, during laparoscopic inguinal hernia and completely to avoid adhesion of viscera to the mesh
repair in 117 patients, the peritoneal closure was achieved by and intestinal obstructions by bowel herniation through
percutaneous transabdominal external looped needle. The peritoneal defects into the preperitoneal space. Incom-
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needle was passed directly through the abdominal wall to close
the peritoneal flaps using Vicryl no. 0. The mean follow-up plete peritoneal closure or its breakdown in laparoscopic
period was 28 months. preperitoneal hernia repair increases the risk of bowel
obstruction. The optimal peritoneal closure method in
Results: The age of this patients’ group ranged from 20 to 66
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years (mean age 47 years). The mean time to put one stitch TAPP remains debatable. Here, we presented a novel
was 1.8 minutes. No recurrence, pain, intestinal adhesion, procedure to close the peritoneal flaps during TAPP
obstruction, mesh bulging, or infection was recorded in this repair.
patients’ group during the period of follow-up.
Conclusion: Our technique for peritoneal closure during MATERIALS AND METHODS
laparoscopic inguinal hernia repair (TAPP) is effective, safe,
and easy. This study was done from April 2013 through August
Keywords: Laparoscopic hernia repair, Looped needle, 2015 in General and Laparoscopic Surgery Department,
Peritoneal closure. Zagazig University Hospital, Egypt. One hundred
How to cite this article: Lasheen AE, Sarhan AR, Salem A, seventeen patients were included in this article. This
Shiref T. Percutaneous Transabdominal External Looped research was discussed and approved by the ethical
Needle for Peritoneal Closure in Laparoscopic Transabdominal committee of Zagazig University on January 2013. All
Preperitoneal Inguinal Hernia Repair. World J Lap Surg information about the procedure were discussed with
2016;9(2):58-62.
all the patients, and a written consent was taken from
Source of support: Nil the patients for inclusion of their data in this study. The
Conflict of interest: None age of the patients ranged from 20 to 66 years (mean age,
49 years).

INTRODUCTION
Surgical Technique
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Corbitt first reported the technique of laparoscopic
herniorrhaphy. Subsequently, transabdominal preperito- The TAPP procedure was performed in this patients’
neal (TAPP) approach and totally extraperitoneal (TEP) group under general anesthesia. As usual, the peritoneum
was incised superiorly (3–4 cm) above the hernia defects.
This incision extended from the medial umbilical liga-
1-4 General Surgeon ment to the anterior superior iliac spine laterally. Then
1-4 Department of General and Laparoscopic Surgery, Faculty of dissection of the hernia sac and complete exposure of the
Medicine, Zagazig University, Zagazig, Sharkia, Egypt preperitoneal space were completed. The optimal mesh
Corresponding Author: Ayman Salem, General Surgeon size was prepared to cover all myopectineal orifices, with
Department of General and Laparoscopic Surgery, Faculty of an overlap of at least 3 to 5 cm from the margin of hernia
Medicine, Zagazig University, Zagazig, Sharkia, Egypt, e-mail: defect(s) in all directions. A suitable mesh (polyprolene
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lasheenahmed@yahoo.com
mesh) goes to the preperitoneal space, where it was fixed
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