Supsamutchai Chairat, Pongratanakul Ratanakiat, Jirasiritham Jakrapan, Punmeechao Puvee, Poprom Napaphat, Wilasrusmee Jarinya, Meakleartmongkol Theejutha, Plangsiri Settanan, Wilasrusmee Chumpon
Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Department of Surgery, Fort Surasi Hospital, Siriraj , Thailand.
Sci Rep. 2025 Mar 23;15(1):10030. doi: 10.1038/s41598-025-94683-x.
Seroma formation is one of the most common postoperative complications after laparoscopic inguinal hernia repair (LIHR). Many techniques to reduce the incidence of seroma formation after LIHR have been described; however, the evidence for performing hernial sac transection (HST) technique is limited. Therefore, this study was conceived to evaluate the effect of HST on LIHR. We conducted a systematic review and meta-analysis of comparative studies according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) 2020. The PubMed, Embase, Springer, and the Cochrane databases were searched for relevant publications up to December 2023. Studies concerning laparoscopic inguinal hernia repair with clearly specified surgical techniques were included. Studies were excluded if they were open procedures or non-inguinal hernia repair. Egger's test and funnel plot analysis was used to assess bias. Outcomes were reported as odds ratio for dichotomous outcomes and as confidence intervals for continuous outcomes. No funding was received for this study. The study protocol was registered in PROSPERO under the number ID: CRD.42,024,530,115. A total of 3,076 patients in 9 studies were included in the analysis (4 RCTs, 4 retrospective cohorts, and 1 prospective cohort). Three, four, and two studies evaluated TEP, TAAP, and both techniques, respectively. The rate of seroma in HST transection was 57% lower than that in the reduction method (p value < 0.01), with low evidence of publication bias (Egger test and funnel plots, coefficient, 0.470; SE, 0.722; p = 0.275). In the subgroup analysis, 3 RCTs reported lower rates of seroma formation in HST (RR, 0.57; 95% CI, -0.24, 1.37), but the difference was not statistically significant. The rate of seroma formation in the HST for the TAPP method was significantly lower than that for the reduction method by approximately 53% (p value = 0.03). Compared with complete sac reduction, HST is associated with a lower seroma rate after LIHR.
血清肿形成是腹腔镜腹股沟疝修补术（LIHR）后最常见的术后并发症之一。已有许多描述降低LIHR后血清肿形成发生率的技术；然而，进行疝囊横断术（HST）技术的证据有限。因此，本研究旨在评估HST对LIHR的影响。我们根据系统评价和Meta分析的首选报告项目（PRISMA）2020对比较研究进行了系统评价和Meta分析。检索了截至2023年12月的PubMed、Embase、Springer和Cochrane数据库中的相关出版物。纳入了有关具有明确指定手术技术的腹腔镜腹股沟疝修补术的研究。如果是开放手术或非腹股沟疝修补术的研究则被排除。采用Egger检验和漏斗图分析来评估偏倚。二分类结局报告为比值比，连续结局报告为置信区间。本研究未获得资金支持。该研究方案已在PROSPERO注册，注册号为：CRD.42,024,530,115。分析纳入了9项研究中的3076例患者（4项随机对照试验、4项回顾性队列研究和1项前瞻性队列研究）。分别有3项、4项和2项研究评估了TEP、TAAP以及这两种技术。HST横断术中血清肿发生率比回纳法低57%（p值<0.01），发表偏倚证据较低（Egger检验和漏斗图，系数，0.470；标准误，0.722；p = 0.275）。在亚组分析中，3项随机对照试验报告HST中血清肿形成率较低（风险比，0.57；95%置信区间，-0.24，1.37），但差异无统计学意义。TAPP方法的HST中血清肿形成率比回纳法显著低约53%（p值 = 0.03）。与完全回纳疝囊相比，HST与LIHR后较低的血清肿发生率相关。
