Application of Straight-needle, Three-tailed, Knot-free, Peritoneal Sutures in Laparoscopic Transabdominal Preperitoneal Hernia Repair
Summary
Here, we present a protocol to introduce a new peritoneal suture method. This method is called straight-needle, three-tailed, knot-free suture, and we will outline the manufacturing method and clinical application of this suture in detail.
Abstract
Laparoscopic transabdominal preperitoneal hernia repair (TAPP) is one of the most widely used methods in inguinal hernia surgery. After the mesh is placed, the peritoneum must be resutured to avoid contact with the tissues and organs in the abdominal cavity. If the peritoneal suture time is too long, the operation and anesthesia time will be prolonged, increasing the burden on the patient. Moreover, improper suture methods cause serious consequences, such as intestinal obstruction and mesh infection.
The straight-needle suture method transforms the three-dimensional spatial configuration of the needle holder and the arc needle tip into a two-dimensional planar structure, which greatly reduces the difficulty of suturing. The three-tailed knot can be anchored at the beginning of the suture by its friction and button effect, which has an exact fixation effect. Thus, the suture does not easily slip, and the time to complete the suturing is shortened. Compared with the traditional suture method, the operator can suture the peritoneum more quickly, beginners can pass through the difficult learning curve faster, and skilled operators can also shorten the total operation time of TAPP to a certain extent. Thus, this suture method is extremely amenable to clinical application.
Introduction
Laparoscopic transperitoneal preperitoneal hernia repair is the main method of inguinal hernia repair1. This approach has a short learning curve, allows complete observation of the inguinal anatomy, and is widely applied in the clinic2,3. However, this operation requires a peritoneal incision, and after the placement of the mesh, the peritoneum must be sutured to prevent direct contact between the mesh and the organs in the abdominal cavity and avoid complications such as mesh erosion or adhesive intestinal obstruction4,5.
There are many methods for peritoneal suture. At present, the traditional clinical method is to use absorbable sutures with continuous suturing. As the incised peritoneum is located in the anterior abdominal wall, the angle of the suture needle needs to be continuously adjusted during suture, and knots need to be tied at the beginning and end of each suture6. This suture method requires more time and more skilled endoscopic skills, and beginners require an extended practice period7,8.
Thus, we designed a new method to improve the suturing process using straight-needle, three-tailed, knot-free sutures. The basic principle of this method is to use the two-dimensional structure of the straight needle and the anchoring effect of three knot-free tails in the process of suture to reduce the number of steps and the difficulty of suture. Having used this suture many times and compared it to the traditional method, we determined that this method is simple, easy to learn, safe and effective, with a low incidence of complications, and convenient for clinicians to use.
Protocol
Representative Results
Discussion
As the primary method of laparoscopic hernia repair, TAPP is widely used in the clinic. The main challenge in this operation is the suturing of the peritoneal incision. There is no standard suture method for the TAPP peritoneal incision. Some nonstandard methods lead to postoperative complications, such as inaccurate sutures and contact between the intestinal canal and mesh, resulting in postoperative intestinal adhesion and perforation; improper suturing or knotting; and intestinal canal invasion of the anterior periton…
Offenlegungen
The authors have nothing to disclose.
Acknowledgements
This research was supported by a grant from the Guangdong science and technology plan project, funded by the Department of science and technology of Guangdong Province (grant number: 2021A1515410004).
Materials
| 3-0 VICRYL suture | ETHICON | VCP316 | absorbable suture |
| 3D MAX MESH | BARD | 117321 | Inguinal hernia repair mesh |
| Laparoscopic needle holder | KARL-STORZ | 26173KL | needle holder |
| Laparoscopic separating forceps | KARL-STORZ | 38651ON | separating forceps |
| Laparoscopic system (OTV-S400) | Olympus | CLV-S400_WA4KL530 | 4K HD image large screen surgical laparoscope |
Referenzen
- Oguz, H., Karagulle, E., Turk, E., Moray, G. Comparison of peritoneal closure techniques in laparoscopic transabdominal preperitoneal inguinal hernia repair: a prospective randomized study. Hernia. 19 (6), 879-885 (2015).
- Kane, E. D., et al. Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh. Surgical Endoscopy. 32 (2), 627-637 (2018).
- Uwe, S., Stefan, N., Orestis, L., Boris, J. W., Ines, G. Transabdominal preperitoneal (TAPP) versus Lichtenstein operation for primary inguinal hernia repair – A systematic review and meta-analysis of randomized controlled trials. BMC Surgery. 17 (1), 55 (2017).
- Kazunori, U., Hiroshi, M., Hirotaka, T., Hideki, O., Manabu, Y. New suture: tail clinch knot for transabdominal preperitoneal hernia repair. Asian Journal of Endoscopic Surgery. 8 (1), 98-99 (2015).
- Chihara, N., et al. Absorbable barbed suture device for laparoscopic peritoneal closure after hernia repair via the transabdominal preperitoneal approach: A single-center experience with 257 cases. Asian Journal of Endoscopic Surgery. 12 (2), 162-166 (2019).
- Zhu, Y. L., Liu, Y. C., Wang, M. G. A new suture technique for peritoneal flap closure in TAPP: A prospective randomized controlled trial. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 30 (1), 18-21 (2020).
- Bracale, U., et al. Achieving the learning curve in laparoscopic inguinal hernia repair by Tapp: A quality improvement study. Journal of Investigative Surgery. 32 (8), 738-745 (2019).
- Hiroyuki, K., Takashi, Y., Hideki, U., Kentaro, Y., Shusaku, Y. Learning curve for laparoscopic transabdominal preperitoneal repair: A single-surgeon experience of consecutive 105 procedures. Asian Journal of Endoscopic Surgery. 13 (2), 205-210 (2020).
- Köhler, G., Mayer, F., Lechner, M., Bittner, R. Small bowel obstruction after TAPP repair caused by a self-anchoring barbed suture device for peritoneal closure: case report and review of the literature. Hernia. 19 (3), 389-394 (2015).
- Fitzgerald, H. L., Orenstein, S. B., Novitsky, Y. W. Small bowel obstruction owing to displaced spiral tack after laparoscopic TAPP inguinal hernia repair. Surgical Laparoscopy, Endoscopy & Percutaneous Techniques. 20 (3), 132-135 (2010).
- Sartori, A., et al. Small bowel occlusion after trans-abdominal preperitoneal hernia approach caused by barbed suture: case report and review of literature. Il Giomale di chirurgia. 40 (4), 322-324 (2019).
- Kane, E. D., et al. Comparison of peritoneal closure versus non-closure in laparoscopic trans-abdominal preperitoneal inguinal hernia repair with coated mesh. Surgical Endoscopy. 32 (2), 627-637 (2018).
- Samuel, W. R., et al. Does peritoneal flap closure technique following transabdominal preperitoneal (TAPP) inguinal hernia repair make a difference in postoperative pain? A long-term quality of life comparison. Surgical Endoscopy. 31 (6), 2548-2559 (2017).
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