Little influence of the abandoned sac on seroma formation following laparoscopic transabdominal preperitoneal repair of lateral inguinal hernia.

BACKGROUND

The impact of completely reducing or transecting a hernia sac on seroma formation in laparoscopic surgery for lateral inguinal hernias remains debated. To date, no studies have compared the incidence of seroma in hernia sacs left untouched versus other surgical approaches. Abandoning the hernia sac involves avoiding manipulation of the inguinal canal, unlike the manipulation required for transection or reduction of the hernia sac.

PURPOSE

This study aimed to determine whether manipulation of the inguinal canal contributes to seroma formation following transabdominal preperitoneal (TAPP) repair.

METHODS

A retrospective cohort study was conducted, including 476 of the 584 lateral inguinal hernia lesions treated with TAPP during the study period. Seroma occurrence 4 weeks post-surgery was assessed in the unmanipulated group (n = 233) and the manipulated group (n = 243). Risk factors were analyzed using univariable and multivariable methods, and findings were validated based on hernia classification and estimated hernia volume.

RESULTS

Seroma was observed in 23 cases (9.9%) in the unmanipulated group and 28 cases (11.5%) in the manipulated group, without statistically significant differences. Bendavid staging emerged as the strongest predictor of seroma risk in both univariable (odds ratio 7.1, 95% CI 4.0-12.6, p < 0.001) and multivariable analyses (odds ratio 5.2, 95% CI 3.6-7.6, p < 0.001). The likelihood of seroma increased with advancing Bendavid stage (p < 0.001). Lesions complicated by seroma had significantly larger estimated hernia volumes across stages (Stage 2, p < 0.01; Stage 3, p < 0.01).

CONCLUSION

The abandoned sac does not appear to influence seroma formation following laparoscopic repair of lateral inguinal hernias. Key determinants of seroma formation include hernia stage and volume.