Internal Ring Defect Closure Technique in Laparoscopic Mesh Hernioplasty for Indirect Inguinal Hernia

Area of Science:

• Minimally Invasive Surgery
• Surgical Oncology
• Gastroenterology

Background:

• Seroma formation is a common complication following laparoscopic indirect hernia repair.
• The optimal method for reducing seroma incidence after such procedures remains a subject of debate.
• Internal ring defect closure has emerged as a potentially effective strategy.

Purpose of the Study:

• To introduce and evaluate a technique for internal ring defect closure during laparoscopic mesh hernioplasty.
• To assess the impact of this closure technique on seroma formation, postoperative pain, and hernia recurrence.
• To determine the safety and feasibility of the described closure method.

Main Methods:

• A prospective study involving 77 patients with L3 indirect or scrotal hernias from May 2019 to May 2021.
• Laparoscopic transabdominal preperitoneal (TAPP) repair with internal ring defect closure prior to mesh placement.
• Primary outcomes included seroma formation, pain (Visual Analog Scale), and hernia recurrence, with secondary recording of perioperative data and complications.

Main Results:

• 89 indirect hernias were repaired successfully in 77 patients, with a mean defect size of 3.7 cm.
• Seroma formation occurred in 6.7% of unilateral repairs (mean volume 45.8 ml), resolving spontaneously without intervention.
• No hernia recurrence or chronic pain was observed during a mean follow-up of 9.4 months; mean hospital stay was 18 hours.

Conclusions:

• Internal ring defect closure is a safe and feasible addition to laparoscopic mesh hernioplasty for large indirect hernias.
• This technique significantly reduces postoperative seroma formation and associated complications.
• The approach is recommended for the repair of large indirect or scrotal hernias.