The TAPP (transabdominal preperitoneal) laparoscopic hernia repair requires peritoneal flap closure at the end. What is the primary reason for this closure?

• A To prevent mesh migration into the peritoneal cavity
• B To avoid direct contact between the mesh and intraperitoneal viscera, preventing adhesions and fistula ✓
• C To reduce port-site hernia risk
• D To achieve tension-free mesh fixation

Explanation

In TAPP repair, the peritoneal flap must be closed over the mesh to prevent direct contact between the polypropylene mesh and intraperitoneal organs (bowel, bladder). Direct mesh-viscera contact can lead to serious complications including bowel adhesions, small bowel obstruction, and enterocutaneous fistula formation. This is the fundamental distinction between TAPP (requiring peritoneal closure) and TEP (totally extraperitoneal), where the mesh remains in the preperitoneal space without peritoneal entry.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.