Feasibility and safety of clip versus bipolar vessel-sealing device closure of peritoneal tears in TEP inguinal hernia repair: a retrospective comparative study
Sangar Abdullah1, Mahmut Zenciroğlu1, Ahmet Topçu1, Göktuğ Bora1, Meryem Gözde Kılıç1, Olcay Dulundu1, Tuncer Babur21Department of General Surgery, Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, İstanbul, Türkiye2Department of General Surgery, Kozyatağı Acıbadem Hospital, İstanbul, Türkiye
INTRODUCTION: Peritoneal tears are the most common intraoperative event during totally extraperitoneal (TEP) inguinal hernia repair and are the leading cause of conversion. Several closure techniques have been described, but clip closure has never been directly compared with closure using an energy-based sealing device. This study compared the feasibility and safety of 5-mm titanium clips and a bipolar vessel-sealing device for the closure of peritoneal tears during TEP repair.
METHODS: Patients who underwent elective TEP inguinal hernia repair between January 2023 and May 2025 at a single center were retrospectively reviewed. Of 295 procedures, a peritoneal tear occurred in 74 patients (25.1%); after excluding 7 patients managed using other techniques and 6 lost to follow-up, 61 patients were analyzed (27 clip, 34 vessel-sealing device). Outcomes included the need for Veress needle decompression, conversion, operative time, complications, and recurrence. An additional analysis was performed after excluding inguinoscrotal hernias.
RESULTS: Operative time did not differ between the clip and vessel-sealing device groups (45.9±7.3 vs 46.2±8.7 minutes; p=0.855), nor did the need for Veress needle decompression (3.7% vs 11.8%; p=0.371), early post-operative complications (14.8% vs 11.8%; p=1.000), or recurrence (7.4% vs 5.9%; p=1.000). Conversion occurred in one patient (1.6%). Inguinoscrotal hernias were more frequent in the vessel-sealing device group (29.4% vs 3.7%; p=0.016); excluding these patients did not alter any findings. No bowel obstruction occurred over a median follow-up of 26.3 months.
DISCUSSION AND CONCLUSION: Both techniques appear feasible and safe, with no differences detected between them. As clip closure is not slower, device choice may be guided by availability and cost. These exploratory findings require confirmation in adequately powered studies.
Keywords: Inguinal hernia, peritoneal tear, titanium clip, totally extraperitoneal repair, vessel-sealing device
Manuscript Language: English