Page 13 - World Journal of Laparoscopic Surgery

WJOLS

Percutaneous Transabdominal External Looped Needle for Peritoneal Closure
DISCUSSION of 0.2 to 0.5%. Additionally, the study by Kapiris et al.
reported reduced complaints of persistent inguinal pain
The TAPP procedure has various technical difficulties
and new devices have been developed that solve some as they adopted a stable-free technique for mesh fixation
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of these problems. Complete closure of the peritoneum and peritoneal closure. In our technique for perito-
after TAPP repair is an essential step of the operation to neal closure, the suture (Vicryl no. 0) passed through
avoid on the one hand mesh exposure to the bowel with the upper and lower peritoneal flaps with in between
the risk of adhesion and bowel obstruction and on the part of inner layer of anterior abdominal wall. So, this
other hand bowel incarceration through herniation into prevents cut through, or breakdown of peritoneal
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the preperitoneal space. Penetrating devices, such as flaps and obliteration of any gap. The external looped
tacks, clips, staples, or strap devices should be avoided needle was passed through the anterior abdominal wall
for mesh fixation and also for peritoneal closure, because directly over the peritoneal flaps, so no need of more
8,9
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of the risk of nerve injuries and adhesions. LeBlanc ports or much instruments. The manipulation of this
reported tack hernia as one of the complications after external looped needle is easy to a beginner laparoscopic
using tacks for mesh fixation or peritoneal closure in surgeon also.
lapa roscopic hernia repair. The peritoneal incision
should be noninvasively approximated, for instance, us- CONCLUSION
ing an absorbable, whose ends get fixed with absorbable Peritoneal closure by using an external looped needle
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clips. The patients who had the peritoneum closed with is effective, easy, and needs no much instrumentations
a running suture had reduced incidence (from 0.8–0.1%) or experiences during TAPP repair of inguinal hernia.
of small bowel obstruction from herniation through the
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World Journal of Laparoscopic Surgery, May-August 2016;9(2):58-62 61