The effect of transverse fascia inversion on postoperative seroma in direct hernias treated with laparoscopic TAPP procedure

Abstract

AIM: This study aims to reveal the results of the transverse fascia inversion technique applied in laparoscopic transabdominal preperitoneal (TAPP) procedure to reduce the risk of seroma in direct hernias.

MARIAL AND METHODS: Patients who underwent elective inguinal hernia repair with the laparoscopic TAPP procedure were retrospectively evaluated. Indirect inguinal or femoral hernias and emergency operations were excluded, and only patients with direct or indirect + direct inguinal hernia were included in the study. The patients were divided into two groups as those with and without transverse fascia inverted. Operative and postoperative clinical features were compared.

RESULTS: Sixty-two patients with 75 inguinal hernias were included in our study. Six of the patients were women. Thirty-one patients had a right inguinal hernia, 18 patients had left, and 13 patients had a bilateral inguinal hernia. The operation time was longer in the inversion group, but this was not statistically significant. One-day postoperative pain and postoperative hospital stay were similar in the two groups. In the inversion group, the peritoneal breach occurred in 4 patients, and gonadal vessel injury occurred in 1 patient (p = 0.435, p = 0,376, respectively). When postoperative complications are examined, there was no statistical difference between subcutaneous emphysema, urinary retention, and hematoma development (p>0.005); however, seroma formation was lower in the inversion group (p = 0.031).

CONCLUSION: Inversion and fixing the direct hernia pouch to the cooper ligament reduces the risk of seroma formation in the laparoscopic TAPP procedure.