腹腔鏡修補直接型疝氣降低術後血清腫的不同方法

林瑜萱、歐宴泉、許兆畬、童敏哲、翁瑋駿

童綜合醫院 外科部 泌尿科

Different methods in reduction of seroma formation in laparoscopic repair of direct type hernia

Yu-Hsuan Lin, Yen-Chuan Ou, Chao-Yu Hsu, Min-Che Tung, Wei-Chun Weng

Divisions of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan

Purpose: Seroma, some authors call it pseudorecurrence, is a common postoperative complication after laparoscopic direct inguinal hernia repair, which is known as fluid accumulation in anatomical dead space, causing increase abdominal pressure and abdominal wall to bulge out. Besides, it may increase the risk of infection, resulting in an abscess. The incidence of seroma ranges from 0.5 to 12.2% by the literature review. Here we propose our different techniques and compare them in the prevention of seroma formation after laparoscopic repair of direct inguinal hernia.

Materials and Methods: In this retrospective study, we enrolled 42 consequent patients with a total 53 direct inguinal hernias (with bilateral hernias in 11 cases) by a single surgeon. We excluded patients with indirect hernias. All patients were confirmed with direct inguinal hernias intraoperatively during laparoscopic total extraperitoneal herniorrhaphy(TEP). We classified our technique into three methods (1) defects closure by fascia needle(FN); (2) direct sutures on defect(DS); (3) fixation of pseudo sac on the bone(FP). After the above procedures reducing the defects of dead spaces, non-absorbable meshes were covered onto the abdominal defect in all patients to reinforce the posterior abdominal wall. We compared these three different methods, respectively, with outcomes of surgical times, within 7-day seroma formation and one-month hernia recurrence.

Results: The surgical times in the three groups(FN, DS, and FP in order) were 49.4, 56.3, and 35.6 minutes. The seroma formation rates were 11.3%, 5.7%, and 15%, respectively. One patient had a postoperative one-month recurrence in the FP group. The P values are significant in the groups of surgical times and the rate of seroma formation.

Conclusions: Seroma formation rate is significantly lower in the DS group, and the recurrence rate is zero, although surgical times are longest. It is worth taking extra time to suture the hernia defect to meet the highest patients’ satisfaction.