Abstract
Seroma formation is one of the important postoperative problems in inguinal hernia surgery, especially after scrotal hernia surgery. The present study aimed to present primarily the incidence of seroma after reduction and transection of the hernia sac in endo-laparoscopic scrotal hernia repair, and secondarily the results of early postoperative complications. Patients were divided into two groups TAPP and TEP. These groups were also divided into transection and reduction subgroups. In the reduction group, the hernia sac was completely dissected and pulled to the peritoneal area, while in the transection group, the neck of the hernia sac was cut by ligating, and its distal part was fixed to the posterior abdominal wall. The groups were compared, and data were analyzed. The reduction was performed in 13 (43.33%) of the 30 patients included in the study, and transection in 17 (56.67%). Seroma developed in 2 (15.38%) of the reduction group and 7 (41.18%) of the transection group. There was no statistical difference between the groups (p = 0.229). Cord and testicular complications were seen in 6 (20%) patients, 5 (38.46%) in the reduction group, and 1 (5.88%) in the transection group. No statistical difference was detected between the groups (p = 0.061). Although not statistically significant, seroma was more common in transection, while cord and testicular complications were more common in reduction. If dissection of the hernia sac is difficult, the complete reduction should not be insisted on, and the neck of the sac should be transection by ligating, and its distal part should be fixed to the posterior abdominal wall.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Data availability
Data are available on request from the corresponding author M.Y.
References
Cihan A, Ozdemir H, Ucan BH, et al (2006) Fade or fate. Seroma in laparoscopic inguinal hernia repair. Surg Endosc 20(2):325–328
HerniaSurge Group (2018) International guidelines for groin hernia management. Hernia 22(1):1–165
Klink CD, Binnebösel M, Lucas AH et al (2011) Serum analyses for protein, albumin and IL-1-RA serve as reliable predictors for seroma formation after incisional hernia repair. Hernia 15(1):69–73
Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 17(11):1773–1777
Wantz GE (1991) L'atrophie testiculaire. Un risque de la hernioplastie inguinale [Testicular atrophy. A risk of inguinal hernioplasty]. Chirurgie 117(8):645–652
Bittner R, Arregui ME, Bisgaard T et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal Hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843
Simons MP, Aufenacker T, Bay-Nilsen M et al (2009) European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia 13:343–403
Leibl BJ, Schmedt CG, Kraft K et al (2000) Scrotal hernias: a contraindication for an endoscopic procedure? Results of a single-institution experience in transabdominal preperitoneal repair. Surg Endosc 14(3):289–292
Chai SW, Chiang PH, Chien CY et al (2022) Sac transection versus sac reduction during laparoscopic herniorrhaphy: a systematic review and meta-analysis. Asian J Surg 45(4):981–986
Berney CR (2012) The Endoloop technique for the primary closure of direct inguinal hernia defect during the endoscopic totally extraperitoneal approach. Hernia 16:301–305
Reddy VM, Sutton CD, Bloxham L et al (2007) Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma. Hernia 11:393–396
Li J, Gong W, Liu Q (2019) Intraoperative adjunctive techniques to reduce seroma formation in laparoscopic inguinal hernioplasty: a systematic review. Hernia 23(4):723–731
Ismail M, Garg M, Rajagopal M (2009) Impact of closed-suction drain in preperitoneal space on the incidence of seroma formation after laparoscopic total extraperitoneal inguinal hernia repair. Surg Laparosc Endosc Percutaneous Tech 19(3):263–266
Gao D, Wei S, Zhai C et al (2015) Clinical research of preperitoneal drainage after endoscopic totally extraperitoneal inguinal hernia repair. Hernia 19(5):789–794
Misra MC, Bhowate PD, Bansal VK et al (2009) Massive scrotal hernias: problems and solutions. J Laparoendosc Adv Surg Tech A 19:19–22
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
Suarez-Artacho G, Morales-Conde S, Socas M et al (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
Fang H, Lin R, Lin X et al (2021) Drainage decreases the seroma incidence in laparoscopic transabdominal preperitoneal (TAPP) hernia repair for large inguinoscrotal hernias. Asian J Surg 44:544–548
Ruze R, Yan Z, Qunzheng W et al (2019) Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study. Surg Endosc 33:1147–1154
Pan C, Xu X, Si X, et al (2022) Effect of complete reduction of hernia sac and transection of hernia sac during laparoscopic indirect inguinal hernia repair on seroma. BMC Surg 22:149. https://doi.org/10.1186/s12893-022-01599-8
Choi YY, Kim Z, Hur KY (2011) Transection of the hernia sac during laparoscopic totally extraperitoneal inguinal hernioplasty: is it safe and feasible? J Laparoendosc Adv Surg Tech A 21(2):149–152
Li J, Ji Z, Shao X (2018) Prevention of seroma formation after laparoscopic inguinoscrotal indirect hernia repair by a new surgical technique: a preliminary report. Int J Abdom Wall Hernia Surg 1:55–59
Funding
The authors declared that this study has received no financial support.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
The ethics committee of our institution approved this study.
Research involving human participants and/or animals
Not applicable.
Informed consent
Informed consent was obtained from the patients.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Yildiz, A., Yucel, M. Endo-laparoscopic scrotal hernia surgery: which technique must we choose to reduce seroma—sac transection or complete sac reduction? A prospective study. Updates Surg 76, 607–612 (2024). https://doi.org/10.1007/s13304-023-01666-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13304-023-01666-6