SEROMA PREVENTION TECHNIQUE FOLLOWING ENDOSCOPIC DIRECT INGUINAL HERNIA REPAIR

INTRODUCTION: Seroma formation in immediate postoperative period is known complication after endoscopic direct inguinal hernia repair. AIM: To study effect of catgut endoloop applied at neck of pseudo sac in preventing occurrence of seroma in laparoscopic direct inguinal hernia repair. MATERIALS & METHOD: 150 patients who underwent endoscopic direct hernia repair were included in this study. They were followed for 1 month for development of seroma. In all the patients' pseudo sac dead space was obliterated by using catgut endoloop. RESULT: In all 150 patients it was possible to prevent clinically visible seroma. CONCLUSION: The primary closure of direct inguinal hernia defects with a pre-lied suture loop during endoscopic repair is safe, efficient, and very reliable for the prevention of post-operative seroma formation, without increasing the risk of developing chronic groin pain or hernia recurrence. This technique should be the preferred method over stapling of the transversalis fascia or the insertion of a closed suction drainage device in such a situation. KEYWORD: Direct inguinal hernia, seroma, catgut endoloop, pseudo sac INTRODUCTION: Post-operative seroma formation after endoscopic management of direct inguinal hernia either by total extra-peritoneal (TEP) or transabdominal pre-peritoneal (TAPP) is a known complication. Because it mimics a postoperative recurrence of hernia, seroma has been a concern to patients. It is suggested that fluid remains trapped between the prosthetic mesh and the transversalis fascia (TF) causing, on a few occasions, a tension seroma that may require repeated follow-up visits and needle aspiration, with a potential risk of iatrogenic infection. Incidence reported in the literature is around 4-5 %. Although techniques such as tacking the pseudo sac to Cooper Ligament or closed suction drain are described, few seem to practice any, probably because the majority of them resolve spontaneously or with repeated aspirations. Therefore, it was proposed to adopt simple measure for seroma prevention by obliterating the pseudo sac with Catgut endoloop and reduce risk of iatrogenic injury and chronic post-operative pain at its minimum. MATERIALS & METHODS: The study was prospective type conducted from Jan 2011 to Dec 2012. 150 patients, who underwent laparoscopic direct inguinal hernia repair, were included. Patients were reviewed in the clinic 2 and 6 weeks after the operation. A single surgeon performed all operations. Each of the M2 or M3 direct defects, according to the European Hernia Society (EHS), was included in this study, while small direct hernias were excluded. After reduction of direct hernia, pseudo sac becomes evident. (FIGURE 1) All meshes were unfolded and under vision cavity were deflated without fixing mesh.