Seroma following transabdominal preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive measures

Abstract

BackgroundThe reported range of seroma formation in the literature after TEP repair is between 0.5 and 12.2% and for TAPP between 3.0 and 8.0%. Significant clinical factors associated with seroma formation include old age, a large hernia defect, an extension of the hernia sac into the scrotum, as well as the presence of a residual indirect sac. Seroma formation is a frequent complication of laparoendoscopic mesh repair of moderate to large-size direct (medial) inguinal hernia defects. This present analysis of data from the Herniamed Hernia Registry now explores the influencing factors for seroma formation in male patients after TAPP repair of primary unilateral inguinal hernia.MethodsIn total, 20,004 male patients with TAPP repair of primary unilateral inguinal hernia were included in uni- and multivariable analysis.ResultsUnivariable analysis revealed the highly significant impact of the fixation technique on the seroma rate (non-fixation 0.7% vs. tacks 2.1% vs. glue 3.9%; p < 0.001). Multivariable analysis showed that glue compared to tacks (OR 2.077 [1.650; 2.613]; p < 0.001) and non-fixation (OR 5.448 [4.056; 7.317]; p < 0.001) led to an increased seroma rate. A large hernia defect (III vs. I: OR 2.868 [1.815; 4.531]; p < 0.001; II vs. I: OR 2.157 [1.410; 3.300]; p < 0.001) presented a significantly higher risk of seroma formation. Likewise, medial compared to lateral inguinal hernias had a higher seroma rate (OR 1.272 [1.020; 1.585]; p = 0.032).ConclusionsMesh fixation with tacks or glue, a larger hernia defect, and medial defect localization present a higher risk for seroma development in TAPP inguinal hernia repair.

Lack of advantages of slit mesh placement during laparoscopic transabdominal preperitoneal inguinal hernia repair (TAPP): a single centre, case matched study

“…About the relatively high seroma rate found in both groups of our study, it could be explained for two reasons, in accordance with those reported in a recent study [ 25 ]. In the study period, we didn’t use any technical tricks to prevent the seroma development, as well as the ligation of Transversalis Fascia trough the Röder loop or the fixation of the Transversalis Fascia to the Cooper Ligament through a suture or through a not-absorbable tack.…”

“…As reported by Köckerling et Al., a large hernia defect has a significantly higher risk of seroma formation. Finally, in all cases we had used the fibrin glue as fixation method, which presents a higher risk for seroma development in TAPP inguinal hernia repair [ 25 ].…”

Causes of recurrence in laparoscopic inguinal hernia repair

“…According to these authors, Tissucol provides prosthesis stability leading to a significant reduced incidence of seroma formation and prevention of hematomas at the prosthetic site influencing lower recurrence rate. However, this has been contradicted by a recent study from Kockerling et al [24] who analysed 20,004 male patients with TAPP repair of primary unilateral inguinal hernia. Univariable analysis revealed the highly significant impact of the fixation technique on the seroma rate (non-fixation 0.7% vs. tacks 2.1% vs. glue 3.9%; p < 0.001).…”

Method of the postsurgical seroma prevention in patients with direct groin hernia during transabdominal preperitoneal repair

“…ства, характеристики требуемого имплантата и т.д. В то же время по ряду вопросов, таких как способ фиксации протеза и ушивания брюшины, возможность полной диссекции грыжевого мешка при пахово-мошоночных грыжах, необходимость использования электрокоагуляции, профилактика серомы и др., нет четкой регламентации, и выбор различных технических оперативных приемов остается за оперирующим хирургом [5][6][7].…”

“…Поскольку в стандартном варианте операции выполняется широкая мобилизация брюшины с установкой сетчатого протеза площадью более 150 см 2 , вероятность образования скопления тканевой жидкости вокруг имплантата существует всегда. В то же время клинические проявления серомы чаще всего наблюдаются при операциях по поводу прямых паховых грыж [5,6]. Это в свою очередь может нарушать процесс интеграции сетки в зоне пахового промежутка.…”