Post-operative seroma formation following laparoscopic inguinal hernia repair: a cross-sectional study

Seroma formation is the most frequent complication after laparoscopic hernia repair, and there are reports of seroma being mistaken for recurrences, with the correct diagnosis being made only after groin exploration. Laparoscopic hernia repair, first introduced by LeBlanc and Booth in 1993, has gained increasing popularity over time. The two most common techniques - total extraperitoneal (TEP) and transabdominal preperitoneal - offer advantages such as shorter hospital stays, less postoperative pain, and lower rates of surgical site infection. Hence, this study aims to study the prevalence and associated seroma among patients who underwent laparoscopic hernia repair.

This descriptive cross-sectional study was conducted in the Department of Surgery at a tertiary level hospital over 4 years (January 2020-December 2024), with ethical approval from the Institutional Review Committee. Data were collected using a predesigned proforma and hospital records, including follow-ups at 1 week, 1 month, 3 months, and 6 months post-surgery. Information on hospital stay, antibiotic use, intraoperative complications, and surgical site infections was recorded. A nonprobability convenient sampling method was used. Based on a calculated sample size of 218 and accounting for incomplete data, 250 patients were included. Data were coded in Excel and analyzed using SPSS v24.0 with descriptive statistics.

Among the 250 patients who underwent laparoscopic inguinal hernia repair, seroma formation was observed in 17.6% of cases. Patients who developed seromas had significantly larger hernial orifice and sac sizes compared to those without seromas (P = 0.000 and P = 0.021, respectively). The TEP approach was more frequently used in the seroma group (50%) than in the non-seroma group (25.7%; P = 0.001), suggesting an association between the TEP technique and increased risk of seroma. Operative time did not differ significantly between the two groups, and no intraoperative bowel or bladder injuries were reported. Postoperative outcomes, including chronic pain and recurrence, showed no significant differences between the seroma and non-seroma groups. Surgical site infections were slightly more common in the non-seroma group (9.2 vs. 2.3%, P = 0.952), while port site hematoma was more frequently seen in the seroma group (22.7 vs. 2.4%, P = 0.221), though neither difference reached statistical significance. Rates of scrotal edema were similar between groups, and average hospital stay was comparable, indicating that seroma formation did not significantly affect short-term recovery. Limitations of the study include its single-center design, limited representation of female and obese patients, reliance on clinical diagnosis for seroma detection, and potential bias in surgical approach selection due to surgeon preference. Long-term complications may also be underrepresented due to limited follow-up.

Seroma formation was observed in 17.6% of patients undergoing laparoscopic inguinal hernia repair. It was significantly associated with higher BMI, larger hernial orifice and sac size, and the use of the TEP approach. Although seromas did not significantly affect long-term outcomes such as chronic pain, recurrence, or hospital stay, their presence highlights the need for meticulous surgical technique and close postoperative monitoring. Further multicenter studies are recommended to confirm these findings and develop strategies to reduce seroma incidence. In our cohort, seromas were clinically detected, self-limiting, and did not require additional intervention beyond reassurance and follow-up.