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



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.

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Dr Sze Wai Leong: Department of General Surgery, National University Health System, Singapore, 2Department of General Surgery, Tan Tock Seng Hospital, Singapore.

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Correspondence to F. Usmani.

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Anonymous data were taken from a prospectively collected standing database and no special ethics approval was needed as no identifiable patient data was used.

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All procedures performed in the study involving human participants were in accordance with the ethical standards of the institution and the 1964 Helsinki declaration and its later amendments and comparable ethical standards.

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All patients involved in this study have signed the institution specific informed consent forms and are aware of the possible risks and benefits of the surgery.

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Usmani, F., Wijerathne, S., Malik, S. et al. Effect of direct defect closure during laparoscopic inguinal hernia repair (“TEP/TAPP plus” technique) on post-operative outcomes. Hernia 24, 167–171 (2020). https://doi.org/10.1007/s10029-019-02036-1

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  • Inguinal hernia
  • Direct defect
  • Defect closure
  • Hernia repair