Skip to main content
SpringerLink
Log in

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

  • Original Article
  • Published:
Hernia Aims and scope Submit manuscript

Abstract

Purpose

Seroma formation and recurrence in large inguinal hernia still remain an important clinical complication despite decades since the advent of mesh repair.

Methods

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.

Results

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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Group, HerniaSurge (2018) International guidelines for groin hernia management. Hernia 22(1):1–165. https://doi.org/10.1007/s10029-017-1668-x

    Article  Google Scholar 

  2. Dedemadi G, Sgourakis G, Radtke A, Dounavis A et al (2010) Laparoscopic versus open mesh repair for recurrent inguinal hernia: a meta-analysis of outcomes. Am J Surg 200(2):291–297. https://doi.org/10.1016/j.amjsurg.2009.12.009

    Article  PubMed  Google Scholar 

  3. Eklund AS, Montgomery AK, Rasmussen IC et al (2009) Low recurrence rate after laparoscopic (TEP) and open (Lichtenstein) inguinal hernia repair: a randomized, multicenter trial with 5-year follow-up. Ann Surg 249(1):33–38. https://doi.org/10.1097/SLA.0b013e31819255d0

    Article  PubMed  Google Scholar 

  4. Matthews RD, Anthony T, Kim LT, Wang J et al (2007) Factors associated with postoperative complications and hernia recurrence for patients undergoing inguinal hernia repair: a report from the VA Cooperative Hernia Study Group. Am J Surg 194(5):611–617. https://doi.org/10.1016/j.amjsurg.2007.07.018

    Article  PubMed  Google Scholar 

  5. Burcharth J (2014) The epidemiology and risk factors for recurrence after inguinal hernia surgery. Dan Med J 61(5):B4846

    PubMed  Google Scholar 

  6. Bittner R, Sauerland S, Schmedt CG (2005) Comparison of endoscopic techniques vs Shouldice and other open nonmesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(5):605–615. https://doi.org/10.1007/s00464-004-9049-9

    Article  PubMed  CAS  Google Scholar 

  7. Köckerling F, Bittner R, Adolf D et al (2018) Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures. Surg Endosc 32(5):2222–2231. https://doi.org/10.1007/s00464-017-5912-3

    Article  PubMed  Google Scholar 

  8. Bouras G, Burns EM, Howell AM et al (2017) Linked hospital and primary care database analysis of the impact of short-term complications on recurrence in laparoscopic inguinal hernia repair. Hernia 21(2):191–198. https://doi.org/10.1007/s10029-017-1575-1

    Article  PubMed  CAS  Google Scholar 

  9. Schjøth-Iversen L, Refsum A, Brudvik KW (2017) Factors associated with hernia recurrence after laparoscopic total extraperitoneal repair for inguinal hernia: a 2-year prospective cohort study. Hernia 21(5):729–735. https://doi.org/10.1007/s10029-017-1634-7

    Article  PubMed  Google Scholar 

  10. Siddaiah-Subramanya M, Ashrafi D, Memon B, Memon MA (2018) Causes of recurrence in laparoscopic inguinal hernia repair. Hernia 22(6):975–986. https://doi.org/10.1007/s10029-018-1817-x

    Article  PubMed  Google Scholar 

  11. Schmedt CG, Sauerland S, Bittner R (2005) Comparison of endoscopic procedures vs Lichtenstein and other open mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19(2):188–199. https://doi.org/10.1007/s00464-004-9126-0

    Article  PubMed  CAS  Google Scholar 

  12. Berney CR (2012) The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach. Hernia 16(3):301–305. https://doi.org/10.1007/s10029-011-0892-z

    Article  PubMed  CAS  Google Scholar 

  13. Clout E, Thayaparan M, Douglas C, Berney CR (2018) Long-term follow-up of endoscopic totally extraperitoneal direct inguinal hernia repair using the Endoloop technique. Surg Endosc. https://doi.org/10.1007/s00464-018-6602-5

    Article  PubMed  Google Scholar 

  14. Daes J (2014) Endoscopic repair of large inguinoscrotal hernias: management of the distal sac to avoid seroma formation. Hernia 18(1):119–122. https://doi.org/10.1007/s10029-012-1030-2

    Article  PubMed  CAS  Google Scholar 

  15. Lee SR, Park SS (2018) The novel technique of transabdominal preperitoneal hernioplasty herniorrhaphy for direct inguinal hernia: suture repair of hernia defect wall. J Laparoendosc Adv Surg Tech A 28(1):83–88. https://doi.org/10.1089/lap.2017.0045

    Article  PubMed  Google Scholar 

  16. Li J, Zhang W (2018) Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation? Surg Endosc 32(2):1082–1086. https://doi.org/10.1007/s00464-017-5760-1

    Article  PubMed  Google Scholar 

  17. Zhu Y, Liu M, Li J, Wang M (2019) Closure of direct inguinal hernia defect in laparoscopic hernioplasty to prevent seroma formation: a prospective double-blind randomized controlled trial. Surg Laparosc Endosc Percutan Tech 29(1):18–21. https://doi.org/10.1097/SLE.0000000000000619

    Article  PubMed  Google Scholar 

  18. 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(5):393–396. https://doi.org/10.1007/s10029-007-0233-4

    Article  PubMed  CAS  Google Scholar 

  19. Sürgit Ö, Çavuşoğlu NT, Kılıç M, Ünal Y, Koşar PN et al (2016) Use of fibrin glue in preventing pseudorecurrence after laparoscopic total extraperitoneal repair of large indirect inguinal hernia. Ann Surg Treat Res 91(3):127–132. https://doi.org/10.4174/astr.2016.91.3.12

    Article  PubMed  PubMed Central  Google Scholar 

  20. Jehaes C, Schumpelick V, Wantz GE et al (1995) Laparoscopic extraperitoneal approach for inguinal hernia repair. In: Schumpelick V, Wantz GE (eds) Inguinal hernia repair, illustrated edn. Karger, Basel, pp 169–172

    Google Scholar 

  21. Bittner R, Montgomery MA, Arregui E et al (2015) Update of guidelines on laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia (International Endohernia Society). Surg Endosc 29(2):289–321. https://doi.org/10.1007/s00464-014-3917-8

    Article  PubMed  CAS  Google Scholar 

  22. Li J, Gong W, Liu Q (2019) Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review. Hernia. https://doi.org/10.1007/s10029-019-01903-1

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Author information

Authors and Affiliations

  1. Department of General Surgery, National University Health System, Singapore, Singapore

    F. Usmani, S. Wijerathne & S. Malik

  2. Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore

    C. Yeo & J. Rao

  3. Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    D. Lomanto

Authors
  1. F. Usmani
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Wijerathne
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Malik
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. C. Yeo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Rao
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. Lomanto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Usmani.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest to declare.

Ethical approval

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

Human and animal rights

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.

Informed consent

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.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-019-02036-1

Keywords

Search

Navigation