Skip to main content
SpringerLink
Log in

Preperitoneal closed-system suction drainage after totally extraperitoneal hernioplasty in the prevention of early seroma formation: a prospective double-blind randomised controlled trial

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

A Comment to this article was published on 21 April 2018

Abstract

Objectives

Seroma is a virtually unavoidable early sequela after TEP hernioplasty. This randomised controlled trial evaluated the outcomes of preperitoneal closed-system suction drainage in laparoscopic totally extraperitoneal (TEP) hernioplasty for inguinal hernia.

Methods

Ninety patients aged 18–80 years who presented to our hospital between May 2016 and February 2017 with primary unilateral inguinal hernia were randomised into the preperitoneal drain and no-drain groups. The primary outcome was seroma size on postoperative day 6. Secondary outcomes included clinical seroma formation and seroma size on day 1, day 6, 1 and 7 months postoperatively, length of postoperative stay, pain score, and recurrence.

Results

There was no significant difference in age, sex, co-morbidities, hernia side, mean hernia size, operating time, fixation adjuncts, or postoperative stay. The overall incidence of clinical seroma formation was 25.6% on postoperative day 1, 60.3% on postoperative day 6, 13.2% 1 month and 0% 7 months postoperatively. The mean drain output was 57.9 ml. The drain group had significantly fewer patients with seroma on day 1 (6 vs 14, p = 0.022) and day 6 (17 vs 30, p = 0.000), and a smaller mean seroma size on days 1 and 6 (p = 0.000). Subgroup analysis showed that sac ligation versus reduction, peritoneal perforation, and fixation adjuncts had no significant effects on seroma formation or size. There is a trend of lower early post-operation VAS score and more urinary retention in drain group was observed but not reaching statistical significance. No differences in postoperative pain score or complications were observed at 1 and 7 months’ post operation.

Conclusions

Preperitoneal drainage for 23 h after laparoscopic TEP hernioplasty for inguinal hernia can effectively decrease seroma formation in the early postoperative period, and potentially improving postoperative pain. The benefit is short-term and no significant difference was demonstrated after 1-month post operations. This tradition technique applied to novel operative repair of inguinal hernia is safe and feasible with no significant morbidity demonstrated. Preperitoneal drainage after TEP can be considered as an option to improve patient satisfactions and recovery in selected patient group for maximal benefit, especially for those with prolonged operation which may associate with higher chance of seroma formation.

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
Diagram 1
Chart 1
Chart 2

Similar content being viewed by others

References

  1. Bittner R et al (2011) Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia [International Endohernia Society (IEHS)]. Surg Endosc 25(9):2773–2843

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Bittner R, Schwarz J (2012) Inguinal hernia repair: current surgical techniques. Langenbecks Arch Surg 397(2):271–282

    Article  PubMed  CAS  Google Scholar 

  3. Wauschkuhn CA et al (2010) Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surg Endosc 24(12):3026–3030

    Article  PubMed  Google Scholar 

  4. Fan JK et al (2017) Randomized trial comparing self gripping semi re-absorbable mesh (PROGRIP) with polypropylene mesh in open inguinal hernioplasty: the 6 years result. Hernia 21(1):9–16

    Article  PubMed  CAS  Google Scholar 

  5. She WH et al (2011) Needlescopic totally extraperitoneal hernioplasty for unilateral inguinal hernia in adult patients. Asian J Surg 34(1):23–27

    Article  PubMed  Google Scholar 

  6. Wada H et al (2012) Laparoscopic transabdominal preperitoneal inguinal hernia repair using needlescopic instruments: a 15-year, single-center experience in 317 patients. Surg Endosc 26(7):1898–1902

    Article  PubMed  Google Scholar 

  7. Wijerathne S et al (2014) A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair. Surg Endosc 28(11):3053–3058

    Article  PubMed  Google Scholar 

  8. Tran H (2011) Safety and efficacy of single incision laparoscopic surgery for total extraperitoneal inguinal hernia repair. JSLS 15(1):47–52

    Article  PubMed  PubMed Central  Google Scholar 

  9. Krishna A et al (2012) Laparoscopic inguinal hernia repair: transabdominal preperitoneal (TAPP) versus totally extraperitoneal (TEP) approach: a prospective randomized controlled trial. Surg Endosc 26(3):639–649

    Article  PubMed  Google Scholar 

  10. Lopez-Monclus J et al (2012) Persistent inguinal seroma managed with sprinkling of talcum powder: a case report. J Med Case Rep 6:391

    Article  PubMed  PubMed Central  Google Scholar 

  11. 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

    Article  PubMed  CAS  Google Scholar 

  12. Beacon J, Hoile RW, Ellis H (1980) A trial of suction drainage in inguinal hernia repair. Br J Surg 67(8):554–555

    Article  PubMed  CAS  Google Scholar 

  13. Rodrigues AJ Jr et al (2003) The Stoppa procedure in inguinal hernia repair: to drain or not to drain. Rev Hosp Clin Fac Med Sao Paulo 58(2):97–102

    Article  PubMed  Google Scholar 

  14. Peiper C et al (1997) Value of subcutaneous drainage in repair of primary inguinal hernia. A prospective randomized study of 100 cases. Chirurg 68(1):63–67

    Article  PubMed  CAS  Google Scholar 

  15. Ismail M et al (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 Percutan Tech 19(3):263–266

    Article  PubMed  Google Scholar 

  16. Gao D et al (2015) Clinical research of preperitoneal drainage after endoscopic totally extraperitoneal inguinal hernia repair. Hernia 19(5):789–794

    Article  PubMed  CAS  Google Scholar 

  17. Bittner R 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

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank ZL; GZ; HZ; JL; JW; JS for assisting with creation of a database and patients care. Expert advice from Prof Anil.Sharma. is greatly acknowledged.

Funding

No funding was received for conducting this trial.

Author information

Authors and Affiliations

  1. Department of Surgery, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, HKSAR, China

    J. K. M. Fan, H. K. Choi, F. S. Y. Chan & C. M. Lo

  2. Department of Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

    J. K. M. Fan, J. Liu, K. Chen, X. Yang, F. S. Y. Chan & C. M. Lo

  3. Department of Diagnostic Radiology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

    X. Xu & K. W. H. Chiu

  4. Department of Diagnostic Radiology, Li Ka Shing Faculty of Medicine, Queen Mary Hospital, The University of Hong Kong, HKSAR, China

    K. W. H. Chiu

Authors
  1. J. K. M. Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. X. Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. X. Xu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. K. Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. F. S. Y. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. K. W. H. Chiu
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. C. M. Lo
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

JKMF—Original idea, data analysis, preparation of manuscript, critical revision of manuscript; JL—data collection and follow-up of patients; KC—data collection and follow-up of patients; XX—data collection and follow-up of patients; HKC—critical revision of manuscript; FSYC—original idea, Critical revision of manuscript; KWHC—data collection and follow up of patients; CML—critical revision of manuscript.

Corresponding author

Correspondence to J. K. M. Fan.

Ethics declarations

Conflicts of interest

JKMF declare no conflict of interest; JL declare no conflict of interest; KC declare no conflict of interest; XF declare no conflict of interest; XX declare no conflict of interest; HKC declare no conflict of interest; FSYC declare no conflict of interest; KWHC declare no conflict of interest; CML declare no conflict of interest.

Ethical standard

All procedures involving human participants were performed in accordance with the ethical standards of our institutional research committee and the study was conducted according to the ethical standards of the Helsinki Declaration of 1975.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study after detail explanation of possible complications. Patients were then given at least 24 h for consideration of participating in the clinical trial before operation.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fan, J.K.M., Liu, J., Chen, K. et al. 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, 455–465 (2018). https://doi.org/10.1007/s10029-018-1731-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10029-018-1731-2

Keywords

Search

Navigation