Sato Masanori, Torii Kakeru
Department of Surgery 1, General (Endoscopic) Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Chuouku, Hamamatsu, Shizuoka, 431-3192, Japan.
Surg Endosc. 2025 Mar;39(3):1740-1748. doi: 10.1007/s00464-024-11523-1. Epub 2025 Jan 14.
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.
This study aimed to determine whether manipulation of the inguinal canal contributes to seroma formation following transabdominal preperitoneal (TAPP) repair.
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.
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).
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.
在腹腔镜腹股沟外侧疝修补术中，完全切除或横断疝囊对血清肿形成的影响仍存在争议。迄今为止，尚无研究比较未处理疝囊与其他手术方式血清肿的发生率。与横断或切除疝囊所需的操作不同，不处理疝囊可避免对腹股沟管的操作。
本研究旨在确定腹股沟管的操作是否会导致经腹腹膜前（TAPP）修补术后血清肿的形成。
进行一项回顾性队列研究，纳入研究期间接受TAPP治疗的584例腹股沟外侧疝病变中的476例。在未处理组（n = 233）和处理组（n = 243）中评估术后4周血清肿的发生情况。采用单变量和多变量方法分析危险因素，并根据疝的分类和估计疝体积对结果进行验证。
未处理组有23例（9.9%）出现血清肿，处理组有28例（11.5%）出现血清肿，差异无统计学意义。在单变量（比值比7.1，95%可信区间4.0 - 12.6，p < 0.001）和多变量分析（比值比5.2，95%可信区间3.6 - 7.6，p < 0.001）中，Bendavid分期均是血清肿风险的最强预测因素。血清肿的可能性随Bendavid分期的进展而增加（p < 0.001）。各阶段合并血清肿的病变估计疝体积明显更大（2期，p < 0.01；3期，p < 0.01）。
在腹腔镜腹股沟外侧疝修补术中，不处理疝囊似乎不会影响血清肿的形成。血清肿形成的关键决定因素包括疝的分期和体积。
