A Challenging Scenario in Laparoendoscopic Single-Site Total Extraperitoneal Hernia Repair After Peritoneal Tear: Single Center Experience

Abstract

Purpose: Laparoendoscopic single-site (LESS) surgery has flourished in several fields of surgery and is viewed as a challenging surgery technique.1 Peritoneal tear during total extraperitoneal (TEP) hernia repair brings longer operation time and higher rate of conversion.2 Although there were several studies published to discuss the efficiency of LESS TEP hernia repair, they did not share the experience in the management and the result in LESS TEP hernia repair while the peritoneal tear happened.3–12 Here, we demonstrate and share our experience in management of the peritoneal tear while performing LESS TEP hernia repair. Materials and Methods: We demonstrate a 64-year-old male without history of operation who was diagnosed with bilateral inguinal hernia and admitted for scheduled LESS TEP hernia repair. A peritoneal tear was found while using the balloon dilator to create the preperitoneal space. The surgical technique is prescribed and explained in detail in the video. From January 2014 to August 2014, there were 30 patients receiving LESS TEP in our study and all are reviewed in this study. Patients were divided into two groups based on the peritoneal tear or not during the LESS TEP hernia repair. Preoperative, intraoperative, and postoperative factors were all recorded. The patients were interviewed at outpatient clinics 1 week after discharge. Results: The total operation time was 90 minutes and there was no recurrence/seroma/hematoma noted during the outpatient clinics follow-up (first week and 3 months after operation). In the retrospective study, demographic data were comparable between the two groups. Eleven of the 30 enrolled patients had a peritoneal injury during operation. The mean operation time was longer in the peritoneal tear group (71.8 ± 27.0 minutes) than in the nonperitoneal tear group (56.2 ± 9.6 minutes) (p = 0.0485). There was no conversion to conventional laparoscopic surgery or open surgery in either group. Postoperative results were comparable between both groups in terms of analgesic requirement, pain score, complications, wound length, and hospital stay. Conclusions: The LESS technique is a feasible and safe technique when peritoneal tear happens during inguinal hernia repair in experienced hands. Although the peritoneal tear usually leads to longer operation time, it did not impair patient's convalescence. No competing financial interests exist. Runtime of video: 6 mins 48 secs