Should peritoneal tears be routinely closed during laparoscopic total extraperitoneal repair of inguinal hernias? a reappraisal

Background: Peritoneal tears (PTs) are not uncommon during the course of laparoscopic total extraperitoneal (LTEP) repair of groin hernias. Most endoscopic surgeons advocate routine closure of these tears. Our approach is not to perform routine closure of PTs. The aim of this study was to evaluate the possible effect of our approach on the intra- and postoperative course of patients in whom PTs were left opened. Methods: Prospective data were collected for LTEP repairs of 298 hernias performed in 166 consecutive patients. Results: There were 134 primary and 34 recurrent hernias. In 23% of patients, unilateral or bilateral PTs were observed during the course of operation. Of these, the prevalence of tears was 21.8% for primary repair and 41% for recurrent repair. In 40 patients with PTs, the procedure was accomplished successfully laparoscopically. The early postoperative course was uncomplicated in all patients. Results of outpatient follow-up with a mean observation time of 16 months (range, 2-30) did not reveal any complications that could be attributed to PTs. Conclusions: These data demonstrate that PTs do not have to be routinely closed and the majority of cases may be safely managed without peritoneal closure. We have not observed any intra- or postoperative complications that could be attributed to peritoneal tears.