TAPP Peritoneal Rent Horizontal Mattress Purse String Closure Trick

Surgical technique video case: during trans-abdominal pre-peritoneal (TAPP) repair of abdominal wall hernias, integrity of the peritoneum is carefully protected, hence, peritoneal rents may occur and should be closed to ensure totally extraperitoneal positioning of the mesh. Structural weakness and fragility of the peritoneum make this closure very delicate. Large dissection to avoid tension on peritoneal closure is paramount. Classical baseball stitch has disadvantages, especially for large rents, due to the fragility of the peritoneum, rent may get enlarged, worsening the situation, exposure of the barbes of the thread to the bowel inherent to the baseball stitch technique is another disadvantage. Horizontal Mattress Purse-String closure avoids tension by even distribution of applicated force at once, minimizing barbed suture exposure to the bowel. In the present case one single 15cm 3-0 barbed suture is used to close all of the rents at once. Another technical point is traveling between the rents extraperitoneal, again, to avoid barbed suture exposure.