Seroma following endoscopic extraperitoneal inguinal hernioplasty

Original article


Background: Because it mimics a postoperative recurrence of hernia, seroma has been a concern to patients. There has been no consensus on the management of this condition after endoscopic totally extraperitoneal inguinal hernioplasty (TEP). The objectives of the present study were to evaluate the incidence and treatment of seroma after TEP. Risk factors for the development of seroma were also examined. Methods: A total of 450 consecutive patients who underwent TEP between June 1999 and May 2002 were recruited. All data were collected prospectively. The outcomes of patients who developed seromas were compared to those without this postoperative complication. Regression analysis was performed to identify independent risk factors for seroma formation. Results: The overall incidence of seroma formation was 7.2% (n = 40). The postoperative recovery of patients was not influenced by the development of seroma. The mean size of the seromas was 3.8 cm. Adopted treatment strategies included observation (n = 29), oral lysozyme (n = 10), and percutaneous aspiration (n = 3), but neither of the two interventions appeared to be effective. The seromas resolved spontaneously by an average of 2.4 (mean) months. Significant clinical factors associated with seroma formation included old age, large hernial defects, an extension of the hernia into the scrotum, and the presence of a residual distal indirect sac. By logistic regression, a large hernial defect and an extension of the hernia into the scrotum were found to be independent risk factors for seroma formation. Conclusions: Although seroma is a frequent minor morbidity after TEP, it has no impact on postoperative recovery. Because all seromas invariably resolve, expectant treatment with observation is recommended. Inguinoscrotal hernia carries a four-fold increased risk of developing seroma after TEP.


Laparoscopy Inguinal herniorrhaphy Seroma Totally extraperitoneal hernioplasty (TEP) 



We acknowledge the kind assistance of Tze-Ching Tan, M.D., in editing the manuscript.


  1. 1.
    Aeberhard, P, Klaiber, C, Meyenberg, A, Osterwalder, A, Tschudi, J 1999Prospective audit of laparoscopic totally extraperitoneal inguinal hernia repair: a multicenter study of the Swiss Association for Laparoscopic and Thoracoscopic Surgery (SALTC)Surg Endosc1311151120PubMedGoogle Scholar
  2. 2.
    Aitken, DR, Hunsaker, R, James, AG 1984Prevention of seromas following mastectomy axillary dissection.Surg Gynecol Obstet158327330PubMedGoogle Scholar
  3. 3.
    Bendavid, R, Kux, M 2001


    Bendavid, RAbrahamson, JArregui, MEFlament, JBPhillips, EH eds. Abdominal wall hernias: principles and management.SpringerNew York753756
    Google Scholar
  4. 4.
    Bittner, R, Kraft, B, Kuckuk, B, Leibl, B, Kraft, K 2002

    Ultrasound examination in laparoscopic/endoscopic hernia surgery.

    Fitzgibbons Jr, RJGreenburg, AG eds. Nyhus & Condon’s hernia.Lippincott Williams & WilkinsPhiladelphia95102
    Google Scholar
  5. 5.
    Burak Jr, WE, Goodman, PS, Young, DC, Farrar, WB 1997Seroma formation following axillary dissection for breast cancer: risk factors and lack of influence of bovine thrombin.J Surg Oncol642731CrossRefPubMedGoogle Scholar
  6. 6.
    Cameron, AE, Ebbs, SR, Wylie, F, Baum, M 1988Suction drainage of the axilla: a prospective randomized trial.Br J Surg751211PubMedGoogle Scholar
  7. 7.
    Chen, CY, Hoe, AL, Wong, CY 1998The effect of a pressure garment on post-surgical drainage and seroma formation in breast cancer patients.Sing Med J39412415Google Scholar
  8. 8.
    Ferzli, GS, Kiel, T 1996The role of endoscopic extraperitoneal approach in large inguinal scrotal hernias.Surg Endosc11299302CrossRefGoogle Scholar
  9. 9.
    Filipi, CJ 2002

    The transabdominal preperitoneal laparoscopic herniorrhaphy.

    Fitzgibbons Jr, RJGreenburg, AG eds. Nyhus & Condon’s hernia.Lippincott Williams & WilkinsPhiladelphia255268
    Google Scholar
  10. 10.
    Fitzgibbons Jr, RJ, Camps, J, Cornet, DA, Nguyen, NX, Litke, BS, Annibali, R, Salerno, GM 1995Laparoscopic inguinal herniorrhaphy: results of a multicenter trial.Ann Surg221313PubMedGoogle Scholar
  11. 11.
    Jehaes, C 1995

    Laparoscopic extraperitoneal approach for inguinal hernia repair in Inguinal hernia repair.

    Schumpelick, VWantz, GE eds. Inguinal hernia repair.KargerBasel269272
    Google Scholar
  12. 12.
    Kapiris, SA, Brough, WA, Royston, CM, O’Boyle, C, Sedman, PC 2001Laparoscopic transabdominal preperitoneal (TAPP) hernia repair: a 7-year two-center experience in 3017 patients.Surg Endosc15972975CrossRefPubMedGoogle Scholar
  13. 13.
    Kulbar, DA, Bacilious, N, Peters, ED, Gayle, LB, Hoffman, L 1997The use of fibrin sealant in the prevention of seromas.Plast Reconstr Surg99842849CrossRefPubMedGoogle Scholar
  14. 14.
    Lehr, SC, Schuricht, AL 2001A minimally invasive approach for treating postoperative seromas after incisional hernia repair.JSLS5267271PubMedGoogle Scholar
  15. 15.
    Leibl, BJ, Schmedt, CG, Kraft, K, Ulrich, M, Bittner, R 2000Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair.Surg Endosc14289292PubMedGoogle Scholar
  16. 16.
    Litwin, DE, Pham, QN, Oleniuk, FH, Kluftinger, AM, Rossi, L 1997Laparoscopic groin hernia surgery: the TAPP procedure. Transabdominal preperitoneal hernia repair.Can J Surg40192198PubMedGoogle Scholar
  17. 17.
    Medical Research Council Laparoscopic Groin Hernia Trial Group1999Laparoscopic versus open repair of groin hernia: a randomized comparison.Lancet354185190PubMedGoogle Scholar
  18. 18.
    O’Hea, BJ, Ho, MN, Petrek, JA 1999External compression dressing versus standard dressing after auxillary lymphadenectomy.Am J Surg177450453CrossRefPubMedGoogle Scholar
  19. 19.
    O’Riordain, DS, Kelly, P, Horgan, PG, Keane, FB, Tanner, WA 1999Laparoscopic extraperitoneal inguinal hernia repair in the day-care setting.Surg Endosc13914917CrossRefPubMedGoogle Scholar
  20. 20.
    Papadakis, K, Greenburg, AG 2002

    Preperitoneal hernia repair.

    Fitzgibbons Jr, RJGreenburg, AG eds. Nyhus & Condon’s herniaLippincott Williams & WilkinsPhiladelphia181198
    Google Scholar
  21. 21.
    Park, A, Birch, DW, Lovrics, P 1998Laparoscopic and open incisional hernia repair: a comparison study.Surgery124816822PubMedGoogle Scholar
  22. 22.
    Smith, RS 1971The use of prosthetic materials in the repair of hernias.Surg Clin North Am5113871399PubMedGoogle Scholar
  23. 23.
    Susmallian, S, Gewurtz, G, Ezri, T, Charuzi, I 2001Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication?Hernia5139141PubMedGoogle Scholar
  24. 24.
    Toy, FK, Baily, RW, Carey, S, Chappuis, CW, Gagner, M, Josephs, LG, Mangiante, EC, Park, AE, Pomp, A, Smoot, RT Jr, Uddo, JF Jr, Voeller, GR 1998Prospective, multicenter study of laparoscopic ventral hernioplasty: preliminary results.Surg Endosc12955959PubMedGoogle Scholar
  25. 25.
    Tsimoyiannis, EC, Siakas, P, Glantzounis, G, Koulas, S, Mavridou, P, Gossios, KI 2001Seroma in laparoscopic ventral hernioplasty.Surg Laparosc Endosc11317321PubMedGoogle Scholar
  26. 26.
    White, TJ, Santos, MC, Thompson, CJ 1998Factors affecting wound complications in repair of ventral hernias.Am Surg64276280PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2003

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of Hong Kong Medical Center, Tung Wah Hospital, 12 Po Yan Street, Sheung Wan, Hong Kong SAR

Personalised recommendations