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 clinic^2,3. 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 obstruction^4,5.

<....

Protocol

The protocol was carried out in accordance with the tenets of the Declaration of Helsinki and approved by the ethics review committee of the Sixth Affiliated Hospital of Sun Yat-sen University.

1. Data and grouping

NOTE: From December 2018 to December 2020, laparoscopic TAPP was performed during gastrointestinal, hernia, and abdominal surgery at the Sixth Affiliated Hospital of Sun Yat-sen University. A total of 264 patients with inguinal hernia met the criteria and were included in the study.

1. Select adult and unilateral inguinal hernia patients for the surgery.
2. Apply the fo....

Results

After the placement of the mesh, the incised peritoneum needs to be sutured again. Straight-needle, three-tailed, knot-free sutures were used for the peritoneal suture in the experimental group. The specific suture method has been described in detail in section 3 of the protocol (Figure 2). The control group was sutured with VICRYL suture or barbed suture with an arc needle. The two groups were compared with respect to suture times, operation times, hernia recurrence, mesh infection, seroma,.......

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.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
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