Abstract
Background
Post-operative seroma formation rate is higher in laparoscopic hernioplasty as compared with open repair. Tacking of lax transversalis fascia of direct inguinal hernia is one of the many methods described to reduce the incidence of seroma after laparoscopic inguinal hernioplasty. Our objective is to investigate whether this technique is simple and reliable in reducing the incidence of seroma.
Methods
A retrospective analysis of 548 patients who underwent laparoscopic inguinal hernioplasty between January 2011 and December 2017 was conducted. Patients demographics, operative data and post-operative complications were collected. 38 patients with transversalis fascia tacking were matched using one-to-one propensity score matching with another 38 patients without transversalis fascia tacking. Propensity score-matched analysis and propensity score-adjusted analysis were performed.
Results
Patients who underwent transversalis fascia tacking (tacking group) had a significant lower incidence of post-operative seroma, compared to the non-tacking group tacking vs non-tacking: 5.6% vs 28.6% (p = 0.0097) in propensity-score matched analysis and 5.6% vs 21.3% (p = 0.0153) in propensity-score adjusted analysis. There was no difference noted in the duration of the operation and post-operative complications, in particular post-operative pain.
Conclusions
Tacking of lax transversalis facia to the symphysis pubis and Cooper’s ligament is a simple yet safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty.
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References
McCormack K, Scott NW, Go PM, Ross S, Grant AM (2003) Laparoscopic techniques versus open techniques for inguinal hernia repair. Cochrane Database Syst Rev 1:CD001785
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 19:188–199
Bittner R, Sauerland S, Schmedt CG (2005) Comparison of endoscopic techniques vs Shouldice and other open non mesh techniques for inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Endosc 19:605–615
Schmedt CG, Leibl BJ, Bittner R (2002) Endoscopic inguinal hernia repair in comparison with Shouldice and lichtenstein repair. A systematic review of randomized trials. Dig Surg 19:511–517
Gupta N, Sharma D, Borgaria S, Lal R (2015) Pseudo-recurrence after laparoscopic inguinal hernia repair. Hell J Surg 87(4):303–306
Cihan A, Ozdemir H, Uçan BH, Acun Z, Comert M, Tascilar O, Cesur A, Cakmak GK, Gundogdu S (2006) Fade or Fate. Seroma in laparoscopic hernia repair. Surg Endosc 20:325–328
Ismail M, Garg M, Rajagopal RM, Garg P (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 Tech 19:263–266
Fan JKM, Liu J, Chen K, Yang X, Xu X, Choi HK, Chan FSY, Chiu KWH, Lo CM (2018) Preperitoneal closed-system suction drainage after totally extraperitoneal hernioplasty in the prevention of early seroma formation: a prospective double-blind randomised controlled trial. Hernia 22(3):455–465
Gao D, Wei S, Zhai C, Chen J, Li M, Gu C, Wu H (2015) Clinical research of preperitoneal drainage after endoscopictotally extraperitoneal inguinal hernia repair. Hernia 19(5):789–794
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 post-operative seroma. Hernia 11:393–395
Choi YY, Kim Z, Hur KY (2011) Swelling after laparoscopic total extraperitoneal repair of inguinal hernias: review of one surgeon’s experience in 1,065 cases. World J Surg 35:43–46
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
Li J, Zhang WY (2018) Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation? Surg Endosc 32:1082–1086
Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 20:325–328
Kaul A, Hutfless S, Le H, Hamed SA, Tymitz K, Nguyen H, Marohn MR (2012) Staples versus fibrin glue fixation in laparoscopic total extraperitoneal repair of inguinal hernia: a systemic review and meta-analysis. Surg Endosc 26:1269–1278
Li J, Ji Z, Zhang W (2015) Staple fixation against adhesive fixation in laparoscopic inguinal hernia repair: a meta-analysis of randomized controlled trials. Surg Laparosc Endosc Percutan Tech 25:471–477
Shah NS, Fullwood C, Siriwardena AK, Sheen AJ (2014) Mesh fixation at laparoscopic inguinal hernia repair: a meta-analysis comparing tissue glue and tack fixation. World J Surg 38:2558–2570
Bansal VK, Misra MC, Babu D, Victor J, Kumar S, Sagar R, Rajeshwari S, Krishna A, Rewari V (2013) A prospective, randomized comparison of long-term outcomes: chronic groin pain and quality of life following totally extraperitoneal (TEP) and transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repair. Surg Endosc 27:2373–2382
Winslow ER, Quasebarth M, Brunt LM (2004) Perioperative outcomes and complications of open vs laparoscopic extraperitoneal inguinal hernia repair in a mature surgical practice. Surg Endosc 18:221–227
Patel JA, Kaufman AS, Howard RS, Rodriguez CJ, Jessie EM (2015) Risk factors for urinary retention after laparoscopic inguinal hernia repairs. Surg Endosc 29:3140–3145
Lau H, Patil NG, Yuen WK, Lee F (2002) Urinary retention following endoscopic totally extraperitoneal inguinal hernioplasty. Surg Endosc 16:1547–1550
Sivasankaran MV, Pham T, Divino CM (2014) Incidence and risk factors for urinary retention following laparoscopic inguinal hernia repair. Am J Surg 207(2):288–292
Koch CA, Grinberg GG, Farley DR (2006) (2006) Incidence and risk factors for urinary retention after endoscopic hernia repair. Am J Surg 191:381–3855
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Concept and design: L K R Acquisition, analysis, or interpretation of data: K K L K R. Drafting of the manuscript: K K. Critical revision of the manuscript for important intellectual content: L K R. Statistical analysis Nicholas L Syn, I J-Y W Study, supervision: L K R
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Kumaralingam, K., Syn, N.L., Wee, I.JY. et al. Is tacking the lax transversalis fascia an easy, safe and effective way to reduce the occurrence of seroma after laparoscopic inguinal hernioplasty? A propensity score-matched and -adjusted analysis. Hernia 24, 831–838 (2020). https://doi.org/10.1007/s10029-020-02158-x
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DOI: https://doi.org/10.1007/s10029-020-02158-x