Background
Peritoneal tears are a recognised complication of extraperitoneal inguinal hernia repair (TEP) [1] and can necessitate conversion to transabdominal pre-peritoneal (TAPP) repair due to loss of the extraperitoneal space. To avoid this conversion, which carries with it risks of further complications [2], it is possible to decompress the pneumoperitoneum and complete the TEP repair. This decompression can be performed with a Verres needle at Palmer’s point; however, this decompression is slow, rarely provides a complete decompression and carries the risk of further complications [3].
Technique
When performing a TEP repair of an inguinal hernia using a direct trocar insertion technique below the umbilicus, in the event of creating a pneumoperitoneum due to a peritoneal tear it is possible to incise the umbilical sac under direct vision and thus decompress the pneumoperitoneum and continue with the procedure. This defect can then be closed with a suture at the end of the procedure.
Discussion
The possibility of decompressing the pneumoperitoneum with this technique was made apparent at the time of performing a TEP repair of an inguinal hernia on a patient who had a concurrent umbilical hernia. However, the presence of such a hernia is not a pre-requisite for this method of decompression. The TEP was completed without the need to convert to TAPP. This method can be performed safely whenever a TEP is complicated by a pneumoperitoneum.
References
Lau H, Patil NG, Yuen WK, Lee F (2002) Management of peritoneal tear during endoscopic extraperitoneal inguinal hernioplasty [see comment]. Surg Endosc 16(10):1474–1477
Lovisetto F, Zonta S, Rota E, Bottero L, Faillace G, Turra G, Fantini A, Longoni M (2007) Laparoscopic Transabdominal Preperitoneal (TAPP) hernia repair: surgical phases and complications. Surg Endosc 21(4):646–652
Byron JW, Markenson G, Miyazawa K (1993) A randomized comparison of Verres needle and direct trocar insertion for laparoscopy. Surg Gynecol Obstet 177(3):259–262
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Sinnett, T., Karanjia, N. Decompression of a pneumoperitoneum during an extraperitoneal inguinal hernia repair (TEP) by incision of the umbilical sac under direct vision. Hernia 14, 221 (2010). https://doi.org/10.1007/s10029-009-0605-z
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DOI: https://doi.org/10.1007/s10029-009-0605-z