Seroma/hematoma formation is the most common postoperative complication after laparoscopic inguinal hernia repair. The occurrence of seroma/hematoma remains unclear. The aim of this study was to determine the risk factors for seroma/hematoma formation after transabdominal preperitoneal patch plasty (TAPP). The study enrolled 359 groin hernia patients treated by TAPP at Kumamoto Medical Center between 2014 and 2019. The primary outcome was risk factors for postoperative seroma/hematoma formation after TAPP. The secondary outcomes included recurrence of hernia, postoperative complications, and hospital stay. Among the 359 patients, the incidence rate of seroma/hematoma was 16% (n = 69 patients), and the recurrence rate was 0.3% (n = 1 patient, both sides). In total, there were 452 lesions. Japan Hernia Society (JHS) type II was present in 23% (n = 106) of the total cases but was significantly more common in the postoperative seroma/hematoma group (40%; P = 0.0082). Meanwhile, JHS type I-3 comprised 27% of the total JHS type I group but was significantly higher in the postoperative seroma/hematoma JHS type I group (40%; P = 0.016). Compared with JHS type I, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS type II was 2.77 (95% CI 1.54–4.95). Compared with JHS grade 1/2, the multivariable odds ratio for postoperative seroma/hematoma formation in JHS grade 3 was 2.27 (95% CI 1.28–4.03). Internal inguinal hernia and hernia size ≥ 3 cm were considered risk factors for postoperative seroma/hematoma formation after TAPP.

Investigation of risk factors for postoperative seroma/hematoma after TAPP

Hernia recurrence is an important complication following inguinal hernia repair. Primary closure of ventral hernia defects laparoscopically has been shown to reduce the risk of recurrence and seroma formation. The results for ventral hernias may potentially be applied to direct inguinal hernias. Our aim was to evaluate the value of primary closure of direct defects during laparoscopic inguinal hernia mesh repair in reducing the incidence of early recurrence. A retrospective, single-center cohort study was conducted on cases performed from August 2016 to February 2018. Patients with direct inguinal hernias undergoing elective laparoscopic mesh repair were included. When performed, the direct hernia defect was primarily closed with extracorporeal non-absorbable interrupted sutures followed by standard placement of a lightweight mesh covering myopectineal orifices. Early recurrence was defined as occurring within 1 year of surgery. A total of 75 direct inguinal hernias in 53 patients who underwent surgery and completed at least 1 year of follow-up were analyzed. The mean age of patients was 63 years (range 44–82 years); with majority of patients being male (98.1%). There were no significant differences observed between the two patient populations in terms of demographics, mean operative time and risk factors. In 9 (16.9%) patients, the direct hernias were recurrent hernias and all underwent open mesh repair during the index hernia surgery. The majority of hernia repairs (63 hernias in 45 patients, 85%) were performed via the totally extraperitoneal (TEP) approach. 19 patients (35.8%) with 28 direct inguinal hernias underwent primary closure of the direct defect prior to mesh placement; while, 34 patients (64.2%) with 47 direct hernias did not undergo primary closure. There were 3 direct hernia recurrences (6.4%) at 1 year post-operatively, and all occurred in the non-closure group. In comparison, there were no recurrences in the closure group; however, this difference was not statistically significant (p = 0.289) in our study due to the small sample size. Closure of direct inguinal hernia defects during laparoscopic mesh repair has been shown to reduce the incidence of early hernia recurrence in our retrospective study but future randomized controlled trials with large numbers would enable us to draw more robust conclusions and perhaps change the way we perform laparoscopic inguinal hernia repair.

Does primary closure of direct inguinal hernia defect during laparoscopic mesh repair reduce the risk of early recurrence

We read with great interest the recent article by Usmani [1] published in Hernia. The authors reported the results of hernia defect closure with barbed suture in laparoscopic direct inguinal hernia repair and reported that the reduced seroma formation rate and postoperative recurrence rate were achieved. We completely agree with the author’s conclusion and the application of this barbed suture technique, we also applaud for the author’s medium term follow-up of these patients, which confirmed the effect of this technique on direct hernia recurrence. Actually, we have introduced and advocated the exact same technique in laparoscopic direct inguinal hernia repair, and we reported the positive results of reduced seroma formation and postoperative recurrence with this technique [2, 3]. We also confirmed the effect of defect closure in laparoscopic direct inguinal hernia repair in a prospective double-blind randomized controlled trial [4]. Furthermore, we emphasized that the defect closure technique was more important when performing laparoscopic direct hernia repair using lightweight meshes [5]. Clinically, we have accumulated our experience with this barbed suture technique and expanded its use from primary to recurrent direct inguinal hernia repairs as well. Based on our routine clinical practice, several important points need to be addressed for the safe and correct application of this technique. Firstly, there is a big difference between inguinal hernia repair and ventral/incisional hernia repair. The repair of a large ventral/incisional hernia usually has the purpose to restore the abdominal function, while inguinal hernia rarely interferes with patients’ abdominal function. Although the direct hernia triangle is bordered by the muscles and inguinal ligament, this region is not for muscle attachment. Therefore, the muscles should not be approximated in direct hernia repair and the sutures should be placed only on the transversalis fascia, but not on the adjacent muscles (transverse abdominal muscle and internal oblique muscle). By doing this, the closure is completely tension-free, otherwise, if the adjacent muscles are incorporated, undue tension would be created, which is absolutely contradictory to the principle of tension-free hernia repair. Theoretically, the aim of this closure is to prevent seroma formation, and prevent mesh dislocation. Both events usually happen in the very early stage after repair, and the transversalis fascia closure would serve as a reasonable barrier to prevent mesh dislocation. Evidently, mesh dislocation or slipping into hernia defect is the main cause for postoperative recurrence, as we could see from a direct hernia recurrence following previous TAPP repair (Figs. 1, 2). Secondly, this closure is also not without risk. In the inferior part of the defect, in particular, the cord structure is just beneath the transversalis fascia, especially in large defects, and the incorporation of this structure must be avoided by the superficial placement of the needle (Fig. 3). Thirdly, we expanded this technique from primary to recurrent hernia repair. In this situation, the previous mesh may exist, and the suture could be placed on the previous mesh safely, thus without any risk of pain or relevant structure injury (Fig. 4). Fourth, we want to emphasis that this method is extremely important in the situation when a lightweight mesh is used to repair a large direct hernia. It was once reported that the use of lightweight mesh was a risk factor in TEP repair [6]. However, it is not the choice of lightweight mesh that should be blamed, but the proper application of the technique. By closing the defect on transversalis fascia, the lightweight mesh could be used safely without the concern of higher recurrence [5]. In our daily practice, we routinely close the large direct hernia defect * J. Li Lijunshenghd@126.com

Comment on "Effect of direct defect closure during laparoscopic inguinal hernia repair ("TEP/TAPP plus" technique) on post-operative outcomes".

Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta-analysis

Is mesh fixation necessary in laparoendoscopic techniques for M3 inguinal defects? An experimental study

Seroma formation and recurrence in large inguinal hernia still remain an important clinical complication despite decades since the advent of mesh repair. In our prospective comparative analysis, we want to evaluate the effect of direct hernia defect closure on surgical outcomes in patients undergoing laparoscopic inguinal hernia repair in two tertiary care institutions in Singapore. The direct hernia defects were closed with non-absorbable sutures incorporating the pseudosac. A group of 241 patients underwent laparoscopic inguinal hernia mesh repair for a total of 378 direct defects from April 2014 to July 2018. Of these patients, 98 (40.6%) patients underwent hernia repair without closure of their direct defect while 143 (59.4%) patients underwent direct defect closure. No significant differences were observed between the two patient populations’ demographic information and the mean operative time. A total of 219 direct defects were closed and 159 direct defects were not repaired. Compared to the group that did not undergo direct defect closure, the group that had closure of the direct defects demonstrated a statistically significant reduction in recurrence (4.4% versus 0.9%, p = 0.036) and seroma formation (12.6% versus 6.4%, p = 0.045). Direct defect closure has proven to be effective in reducing recurrence and seroma formation post-operatively in patients undergoing laparoscopic inguinal hernia repair. Randomized controlled trials will be required to further evaluate these outcomes.

Effect of direct defect closure during laparoscopic inguinal hernia repair (“TEP/TAPP plus” technique) on post-operative outcomes

Handle everyday research tasks with reliable, citation-backed results

Your personal Research Agent to handle research tasks with citation-backed results

Popular Tasks used by Researchers

How can I help with your research?

Meet SciSpace

Get more enhanced response by uploading the PDFs you want me to reference.

No relevant PDFs in your library

SciSpace is the AI research assistant for academics. Run systematic literature reviews on 280M+ papers, and write papers with cited sources. Trusted by 1M+ students, PhDs & researchers.

SciSpace | AI for Research

Analyze PDFs

Code & Manuscripts

Funding & Grants

Literature & Patents

Medical & Clinical Data

Systematic Review

Visualize & Present

Web & Data

Build a Google Scholar-like website for your research.

Build a website

Create charts and images for your research

Create a Chart

Write a paper for submission to a journal

Draft a manuscript

Patent Search

Design eye-catching scientific posters in minutes.

Scientific Poster Generation

Systematic Literature Review

One task is running at the moment. Your messages will be shown right after.

Drag and drop or click here to browse

Loved by <highlight>1 million+</highlight> researchers

Extract a list of specific topics and their sources from unstructured text

Topics

Compare and analyze relevant papers that matches with your search

Papers

Get insights from PDFs and bookmarked papers from your library

My library

Recent searches

Try searching for:

Catch AI-generated content in scholarly and non-scholarly content

{ai} Detector

Ai Writer

Get PDF Summaries, highlighted text explanations 

Chat with PDF

Effortlessly create in-text citations and bibliographies in APA and 2,500 other formats

Citation generator

Get explanations, summaries, and answers on academic papers

Ease up your research workflow with {scispace}'s cohort of exciting AI tools

Elevate your academic writing skills and convey your ideas the way you want

Paraphraser

Explore our range of reading and writing tools

Your file is being prepared and should be ready in a few minutes. If it's a large file, it might take a bit longer. You can close this window, and we'll email you the file when it's done.

You have reached a maximum limit of <strong>{limit}</strong> columns in the table. Remove at least <strong>1</strong> column to add or create another one.

C Yeo

Author Tools

Chat about Author

Papers

Effect of direct defect closure during laparoscopic inguinal hernia repair (“TEP/TAPP plus” technique) on post-operative outcomes