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Updated: Feb 25, 2026
Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Published on: November 12, 2021
Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia
Erica D Kane1, Marc Leduc2, Kathryn Schlosser2
1Department of Surgery, University of Massachusetts Medical School-Baystate Medical Center, 759 Chestnut Street, Springfield, MA, 01199, USA. Erica.KaneMD@baystatehealth.org.
Insights
Leaving the peritoneal layer open during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair with coated mesh is safe and effective. Non-closure reduces operative time without compromising patient outcomes or increasing complication risks.
Area of Science:
- Minimally Invasive Surgery
- Surgical Innovation
- Hernia Repair
Background:
- Peritoneal closure in laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair is standard to prevent mesh-related adhesions and bowel obstruction.
- Newer coated meshes may allow for safe non-closure of the peritoneal layer.
- Limited literature exists on the outcomes of non-closure techniques.
Purpose of the Study:
- To compare outcomes of peritoneal flap closure versus non-closure in primary laparoscopic TAPP inguinal hernia repair using coated mesh.
- To evaluate procedure-related adverse outcomes, operative time, pain resolution, and hernia recurrence.
- To assess the safety and efficacy of leaving the peritoneal layer open.
Main Methods:
- Retrospective comparison of patients undergoing laparoscopic TAPP inguinal hernia repair between January 2005 and August 2016.
- Analysis of primary outcome (procedure-related adverse events) and secondary outcomes (operative time, pain, symptoms, recurrence).
- Comparison between groups with peritoneal flap closure and non-closure, with attention to hernia characteristics and mesh type.
Main Results:
- 231 patients: 55 (24%) closure, 176 (76%) non-closure. Comparable demographics except for obesity, smoking status, and hernia side.
- Mean operative time significantly shorter in the non-closure group (76.8 min vs. 98.1 min).
- Similar rates of pain resolution, post-operative pain, and hernia recurrence between groups. No bowel obstructions or surgical site infections reported.
Conclusions:
- Equivalent patient outcomes observed for both peritoneal closure and non-closure techniques in laparoscopic TAPP inguinal hernia repair.
- Non-closure significantly reduces operative time.
- Further research with larger populations and longer follow-up is needed to confirm long-term complication rates for flap non-closure.
Background:
Peritoneal closure during laparoscopic trans-abdominal preperitoneal (TAPP) inguinal hernia repair has been the standard of care to prevent bowel obstruction due to adhesions generated by contact with mesh. However, with newer coated meshes, leaving the peritoneal layer open may be safe. While many studies compare methods of peritoneal flap closure, there is a deficit of literature reporting the outcomes of non-closure.
Methods:
A retrospective comparison of peritoneal flap closure versus non-closure during primary laparoscopic TAPP inguinal hernia repair with coated mesh was performed for all patients at Baystate Medical Center meeting inclusion criteria between January 2005 and August 2016. Primary outcome was any procedure-related adverse outcome following repair. Secondary outcomes included operative time, resolution of pre-operative pain and/or gastrointestinal symptoms, and hernia recurrence.
Results:
Of 231 patients, 55 (24%) underwent peritoneal flap closure and 176 (76%) underwent non-closure. Demographic, comorbidity, and hernia characteristics were comparable between groups with the exception of obesity (p = 0.01), current smoking status (p = 0.05) and hernia side [p = 0.04 (left), 0.0003 (right)]. Mean operative time was higher in the closure group than non-closure (98.1 ± 37.1 min vs. 76.8 ± 32.9, p < 0.0001). No cases were converted to open. Average follow-up was 21.6 ± 23.8 months. Ninety-three percent of closure patients had documented resolution of pre-operative pain versus 94.0% of non-closure (p = 0.81). The closure group experienced a higher percentage of post-operative complications, though this did not reach significance (5.5 vs. 2.3%; p = 0.36). Compared to the closure group, the non-closure groups experienced similar post-operative pain (3.6 vs. 1.2%; p = 0.24) and recurrence rate (1.8 vs. 4.0%; p = 0.68). There were no bowel obstructions, surgical site infections, unplanned readmissions, or unplanned re-operations.
Conclusions:
Equivalent patient outcomes were seen for both procedure types post-operatively and during follow-up. Operative times were significantly shorter for non-closure patients. Larger study population and longer follow-up is necessary to evaluate true long-term complication rates in flap non-closure.
