title: Impact of peritoneal tears on the outcome and late results (4 years) of endoscopic totally extra-peritoneal inguinal hernioplasty.
abstract: BACKGROUND
  The reported rate of intra-operative peritoneal laceration during endoscopic extra-peritoneal hernioplasty (TEP) ranges from 10 to 64%.
  
  
  OBJECTIVE
  To evaluate in a prospective study the predictive factors of peritoneal tears, their consequences in terms of outcome and late results.
  
  
  METHODS
  Between July 1994 and December 2000, we performed 467 endoscopic extra-peritoneal hernia repairs (TEP). In 14.8% of the cases, single or multiples recurrences after conventional open herniotomy were treated. One hundred and forty-nine patients (38%) had had previous surgery (appendectomy); 277 procedures (70.8%) were performed by experienced surgeons and 114 (29.2%) by surgical trainees. We used a diathermic hook in 26.3% of the procedures. The mean follow-up period was 68 months (48-100).
  
  
  RESULTS
  Peritoneal tears occurred in 43 patients (10.9%). Six of them (13%) required operative closure, and six a conversion (four Lichtenstein, one Shouldice, and one TAPP). In 37 cases (86%), the tears were not closed. Peritoneal tears were significantly correlated with surgical experience, Nyhus classification, scar adhesion from previous surgery and the use of sharp instruments. Peritoneal tears interfere significantly (P=0.001) with the operating time (82 vs. 63 min) and conversion rate (13.9 vs. 1.7%). It does not affect the outcome and late results in terms of recurrences, pain, or small bowel obstruction.
  
  
  CONCLUSIONS
  Our data suggest that peritoneal tears in the vast majority of cases may be safely managed without peritoneal closure. In case of peritoneal laceration, the operative time was significantly longer, and the conversion rate was increased. These situations do not affect the outcome and late complications compared with the procedures without peritoneal tears.
authors.affiliation: Service de Chirurgie Digestive, Université Paris XIII, CHU Jean Verdier, Avenue du 14 Juillet, 93143, Bondy Cedex, France.
authors.forename: G
authors.initials: G
authors.lastname: Muzio
authors.forename: K
authors.initials: K
authors.lastname: Bernard
authors.forename: C
authors.initials: C
authors.lastname: Polliand
authors.forename: N
authors.initials: N
authors.lastname: Rizk
authors.forename: G
authors.initials: G
authors.lastname: Champault
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D022125:Lacerations / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000293:injuries*; D016896:Treatment Outcome