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Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study

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Seroma is the most common early minor complication of inguinal hernia repair. Seromas generally resolve spontaneously within a few weeks, but can sometimes cause other complications. The optimal ways to repair inguinal hernia and handle the hernial sac are still debatable. Large scale, prospective, randomized, controlled studies focusing on the correlation between transection of the hernial sac and seroma formation are scarce.


A total of 159 adult male patients with primary indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal repair were recruited. The patients were randomized to undergo either complete dissection or transection of the hernial sacs. Patients were followed up at postoperative 7 days, 1 and 3 months, looking specifically for seroma. Seroma was diagnosed via physical examination, and a prestructured form was used to evaluate patient recovery and define the type of seroma present at each follow-up visit.


There were 83 patients in the completely dissected group and 76 in the transected group. The overall incidence of postoperative seroma was 12.6% (n = 20). The χ2 test demonstrated that significantly more patients developed seroma in the transected group than in the completely dissected group (18.4% vs. 7.2%, p = 0.034); there were also significant differences between the two groups in the incidences of seroma at postoperative 7 days (18.4% vs. 6.0%, p = 0.016) and 1 month (14.5% vs. 4.8%, p = 0.037). Seroma formation was correlated with age, body mass index, use of anticoagulants, hernia type, hernia size, sac size, and operative time. There were no significant differences between the two groups in the degree of postoperative pain and time taken for the resumption of outdoor activities.


When using the laparoscopic transabdominal preperitoneal technique for indirect inguinal hernia repair, the risk of postoperative seroma formation is greater after transection compared with complete dissection of the hernial sac.

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  1. Cihan A, Ozdemir H, Ucan BH, Acun Z, Comert M, Tascilar O, Cesur A, Cakmak GK, Gundogdu S (2006) Fade or fate. Seroma in laparoscopic inguinal hernia repair. Surg Endosc 20:325–328

    Article  CAS  PubMed  Google Scholar 

  2. Edwards C, Angstadt J, Whipple O, Grau R (2005) Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma related cellulites. Am Surg 71:931–935

    CAS  PubMed  Google Scholar 

  3. Sodergren MH, Swift I (2010) Seroma formation, method of mesh fixation in laparoscopic ventral hernia repair—highlights of a case series. Scand J Surg 99:24–27

    Article  CAS  PubMed  Google Scholar 

  4. Bittner R, Arregui ME, Bisgaard T, Dudai M, Ferzli GS, Fitzgibbons RJ, Fortelny RH, Klinge U, Kockerling F, Kuhry E, Kukleta J, Lomanto D, Misra MC, Montgomery A, Morales-Conde S, Reinpold W, Rosenberg J, Sauerland S, Schug-Paß C, Singh K, Timoney M, Weyhe D, Chowbey P (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)]. Surg Endosc 25:2773–2843

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Simons MP, Aufenacker T, Bay-Nilsen M, Boullot L, Campanelli G, Conze J, Lange D, Fortelny R, Heikkinen T, Kingsnorth A, Kukleta J, Morales-Conde S, Nordin P, Schumpelick V, Smedberg S, Smietansky M, Weber G, Miserez M (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty incidence and risk factors. Surg Endosc 17:1773–1777

    Article  CAS  PubMed  Google Scholar 

  7. Leibl BJ, Schmedt CG, Kraft K, Ulrich M, Bittner R (2000) Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair. Surg Endosc 14:289–292

    Article  CAS  PubMed  Google Scholar 

  8. Asuri Krishna MC, Misra VK, Bansal S, Kumar S, Rajeshwari Chabra A (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26:639–649

    Article  PubMed  Google Scholar 

  9. Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267

    Article  CAS  PubMed  Google Scholar 

  10. Gilbert AI (1989) An anatomic and functional classification for diagnosis and treatment of inguinal hernia. Am J Surg 157(3):331

    Article  CAS  PubMed  Google Scholar 

  11. Susmallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma alter laparoscopic repair of hernia with PFE match: is it really a complication? Hernia 5:139–141

    Article  CAS  PubMed  Google Scholar 

  12. Daes J (2014) Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation. Hernia 18:119–122

    Article  CAS  PubMed  Google Scholar 

  13. Reddy VM, Sutton CD, Bloxham L, Garcea G, Ubhi SS, Robertson GS (2007) Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma. Hernia 11:393–396

    Article  CAS  PubMed  Google Scholar 

  14. Suarez-Artacho G, Morales-Conde S, Socas M, Barranco A (2013) Influence of fibrin sealant in preventing postoperative seroma and normalizing the abdominal wall after laparoscopic repair of ventral hernia. Surg Endosc 27:3214–3219

    Article  PubMed  Google Scholar 

  15. Kadakol AK, Nypaver TJ, Lin JC, Weaver MR, Karam JL, Reddy DJ, Haddad GK, Shepard AD (2011) Frequency, risk factors, and management of perigraft seroma after open abdominal aortic aneurysm repair. J Vasc Surg 54(3):637–643

    Article  PubMed  Google Scholar 

  16. Tomita K, Yano K, Masuoka T, Matsuda K, Takada A, Hosokawa K (2007) Postoperative seroma formation in breast reconstruction with latissimus dorsi flaps: a retrospective study of 174 consecutive cases. Ann Plast Surg 59:149–151

    Article  CAS  PubMed  Google Scholar 

  17. Klink CD, Binnebösel M, Lucas AH, Schachtrupp A, Grommes J, Conze J, Klinge U, Neumann U, Junge K (2011) Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia 15:69–73

    Article  CAS  PubMed  Google Scholar 

  18. Reddy HK, Ujwala J, Swetha M, Ramya SB (2014) Seroma: an interesting case report. Int J Reprod Contracept Obstet Gynecol 3:254–257

    Article  Google Scholar 

  19. Aravind B, Cook A (2015) Intra-abdominal giant infected seroma following laparoscopic inguinal hernia repair. Hernia 19:795–797

    Article  CAS  PubMed  Google Scholar 

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The authors thank Ph.D. student Alim Dayim for performing logarithmic regression analysis.

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Correspondence to Guangyong Zhang.

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Rexiati Ruze, Zhibo Yan, Qunzheng Wu, Hanxiang Zhan, and Guangyong Zhang all have no conflicts of interest or financial ties to disclose.

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Ruze, R., Yan, Z., Wu, Q. et al. Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study. Surg Endosc 33, 1147–1154 (2019).

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