Preperitoneal desufflation after peritoneal closure during TAPP repair: an intraoperative feasibility study
Kryspin Mitura1,2, Krystian Kisielewski3, Laura Kacprzak4,3
1Faculty of Medical and Health Sciences, University of Siedlce, Siedlce, Poland. chirurgia.siedlce@gmail.com.
Background:
After peritoneal closure in transabdominal preperitoneal (TAPP) inguinal hernia repair, direct visual control of mesh positioning is lost, although dynamic changes within the preperitoneal space continue. This limitation may be clinically relevant in contemporary non-fixation strategies using three-dimensional meshes. This study evaluated the feasibility and intraoperative utility of controlled preperitoneal desufflation (CPD) performed after peritoneal closure during TAPP repair.
Methods:
This prospective feasibility study included consecutive adult patients undergoing elective non-fixation TAPP inguinal hernia repair between February 2024 and June 2025. After peritoneal closure, CPD was performed by gradual evacuation of preperitoneal gas under direct laparoscopic visualization. Feasibility, success rate, need for intraoperative corrections, and immediate safety parameters were assessed descriptively.
Results:
A total of 157 repairs were analyzed. CPD was attempted in 141 repairs (89.8%) and successfully completed in 132 cases (93.6%). Intraoperative corrections were required in 50 repairs (35.5%), most commonly due to inferior mesh edge folding and hernia sac invagination. Most corrections were resolved with a single correction cycle. Peritoneal suture disruption occurred in four repairs (2.8%) and did not require reopening of the peritoneal flap. Final mesh position was considered acceptable in all repairs in which CPD was attempted. Surgeon-reported usefulness was high.
Conclusions:
Controlled preperitoneal desufflation is a feasible and reproducible adjunct to TAPP repair that restores intraoperative control over final mesh positioning and enables correction of unfavorable configurations before completion of surgery.