INTRAPERITONEAL ADHESIONS IN LAPAROSCOPIC AND STANDARD OPEN HERNIORRHAPHY - AN EXPERIMENTAL-STUDY

Background: Intra-abdominal complications from transabdominal properit oneal (TAP) laparoscopic herniorrhaphy that would nor be expected to o ccur in an open herniorrhaphy are possible, In a previous study, eve r eported the incidence of significant intra-abdominal adhesions From TA P herniorrhaphies using polypropylene in pigs. Methods: To compare thi s with an open herniorrhaphy technique. we performed open herniorrhaph ies on 31 pigs. Additional animals underwent TAP herniorrhaphy with PT FE, Data were collected on operative and trocar-site adhesions. Graft incorporation was recorded, Results: No intra-abdominal adhesions were found in the 31 animals undergoing open herniorrhaphy. Fifteen adhesi ons were found in the 31 pigs that underwent TAP herniorrhaphy. These adhesions were graded and there were a total of nine significant adhes ions with the TAP procedure. A total of 124 trocar sites resulted in t wo adhesions, Laparoscopically placed polypropylene was better incorpo rated than PTFE. The laparoscopically placed PTFE grafts commonly were poorly incorporated. Conclusions: We conclude that there is a risk of intraabdominal adhesions to either the operative site or the trocar s ites in TAP herniorrhaphy that is not present in open techniques, One should, therefore, be circumspect in the choice of TAP herniorrhaphy a s a primary repair.