ObjectiveTo observe the pathological changes of the peritoneum before and after the total extraperitoneal herniorrhaphy via preperitoneal space approach for incisional hernia in rats, and to explore the effects on the ischemia and necrosis of the peritoneum and its function after the extensive dissociation of the preperitoneal space and the implantation of the patch. MethodsA total of 80 SD rats were randomly divided into normal control group (n=8), hernia model control group (n=8), patch implantation blank control group, and hernia model patch repair group. Eight rats were randomly selected at week 1, 4, 8, and 12 after patch implantation from the patch implantation blank control group and hernia model patch repair group. The normal peritoneum and surrounding tissues were taken from the normal control group, and the peritoneal tissues near the incision were taken from the hernia model control group, patch implantation blank control group, and the hernia model patch repair group. The hematoxylin-eosin staining was performed to observe the pathological changes of the peritoneum. The degrees of inflammatory cell infiltration and fiber hyperplasia among the different groups were compared. Results① Comparison of the degree of inflammatory cell infiltration in the peritoneal tissue, which in the patch implantation blank control group at week 1 and 4 after patch implantation was more severe than the normal control group (P＜0.001, P=0.005) respectively, which at week 8 after patch implantation was alleviated (P=0.021) as compared to the 1st week after patch implantation in the patch implantation blank control group, which had no statistic difference between the patch implantation blank control group and normal control group (P=0.102), which at the 1st week after patch implantation was more severe than hernia model control group (P=0.014), which was alleviated at week 8 and 12 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group (P=0.040, P=0.040), which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ② Comparison of the degree of fiber hyperplasia in the peritoneal tissue, which at week 1, 4, and 12 after patch implantation was more severe (P＜0.001, P=0.003, P＜0.001, respectively) in the patch implantation blank control group as compared with the normal control group; which was alleviated at week 8 after patch implantation as compared to the 1st week after patch implantation in the hernia model patch repair group（P=0.017); which was more severe in the hernia model control group as compared with the normal control group (P=0.012); which had no statistical differences between the hernia model control group and the hernia model patch repair group at different time point (P>0.05); which had no obvious change between-time point in the hernia model patch repair group (P>0.05); which had no statistic differences between the patch implantation blank control group and the hernia model patch repair group at same time point after patch implantation (P>0.05). ConclusionsBased on the experimental results of this study, hernia itself will not stimulate inflammatory cell infiltration and fiber hyperplasia of peritoneal tissue. However, during the process of total extraperitoneal herniorrhaphy via preperitoneal space approach, extensive peritoneal space dissociation and patch implantation will cause peritoneal injury and affect its function. But through the body itself repair, the function caused by peritoneal injury can be fully restored to normal status on the 8th week after patch implantation.