title: Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty.
abstract: BACKGROUND
  Peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty (TEP) results in pneumoperitoneum and loss of extraperitoneal space. To avoid bowel adhesions, internal herniation, and mesh migration, closure of the peritoneal opening is preferred. The present study was conducted to evaluate the efficacy of various operative techniques for the closure of peritoneal laceration.
  
  
  METHODS
  Between April 2000 and May 2001, 100 consecutive patients undergoing 123 TEPs were recruited for the present study. The incidence of peritoneal tear and techniques for the closure of peritoneal opening were documented. Operative time and postoperative morbidity were compared among groups for which different closure methods of peritoneal laceration were used.
  
  
  RESULTS
  The incidence of peritoneal tear was 47%. The mean operative times of unilateral TEPs with and without peritoneal laceration were 66 min and 53 min, respectively (p<0.05). Techniques for the closure of the peritoneal opening included endoscopic stapling (n = 12), endoscopic suturing (n = 14), and pretied suture loop ligation (n = 21). The mean operative times for unilateral TEPs with endoscopic stapling, pretied suture loop ligation, and endoscopic suturing of peritoneal tear were 53, 64, and 82 min, respectively (p<0.05). Comparison of postoperative morbidity showed no significant differences among the three groups.
  
  
  CONCLUSIONS
  Peritoneal tear is a frequent and challenging intraoperative event during TEP. Its occurrence significantly prolongs the length of operation. Endoscopic stapling and pretied suture loop ligation are safe and quick techniques for the closure of peritoneal tear during TEP.
authors.affiliation: Department of Surgery, University of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong. lauh@hkucc.hku.hk
authors.forename: H
authors.initials: H
authors.lastname: Lau
authors.forename: N G
authors.initials: NG
authors.lastname: Patil
authors.forename: W K
authors.initials: WK
authors.lastname: Yuen
authors.forename: F
authors.initials: F
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020776:Endoscopes, Gastrointestinal / Q000009:adverse effects*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology / Q000209:etiology; D022125:Lacerations / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000601:surgery; D010537:Peritoneum / Q000293:injuries* / Q000601:surgery*; D011027:Pneumoperitoneum / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D017792:Surgical Stapling; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors; D016896:Treatment Outcome