Risk Factors for Peritoneal Tear in Laparoscopic Totally Extraperitoneal Inguinal Hernioplasty

Peritoneal tears (PTs) are an intraoperative complication that may occur during extraperitoneal space opening or hernia sac dissection in laparoscopic total extraperitoneal hernia repair (TEP) surgeries and are an important cause of conversion. There is also no consensus on the prevention and causes of this condition in TEP. The aim of this study was to evaluate the risk factors underlying the development of peritoneal tears during TEP.

We included 288 consecutive patients who underwent TEP between May 2019 and December 2023. All data were collected retrospectively. Patients who developed PTs and those who did not develop PTs were compared in 2 groups. The demographic characteristics of the patients, hernia types, hernia defect diameters, surgery times, and intraoperative and postoperative complications were compared. Multivariate analysis identified independent risk factors for PTs in TEP.

The overall incidence of PTs was 22.2% (n=64). The median age was 50.4±14.5 years and the body mass index was 25.9±2.9 kg/m 2 . Significant clinical factors associated with PTs included body mass i̇ndex (BMI), previous surgery, presence of scrotal hernia, and the defect size of inguinal hernia. Multivariate analysis identified independent risk factors for PTs: previous lower abdominal surgery and scrotal hernia.

Peritoneal tears are an intraoperative event that is the most important reason for conversion in TEP surgeries. The most important independent risk factors for peritoneal tear formation were scrotal hernia and previous lower abdominal surgery.