Risk factors for postoperative seroma after TEP inguinal hernia repair: a retrospective analysis of 477 patients

Postoperative seroma remains one of the most common early complications after laparoscopic inguinal hernia repair. Although total extraperitoneal (TEP) repair is widely used due to favorable outcomes, data on independent predictors of seroma formation are inconsistent, and large single-center analyses with standardized technique are limited.

This retrospective study included 477 adult patients who underwent elective TEP inguinal hernia repair between January 2018 and December 2024 at a tertiary referral center. Seroma was defined as a clinically evident fluid collection within 30 days postoperatively and was confirmed by ultrasonography. Demographic, clinical, and operative variables were evaluated. Variables associated with seroma in univariate analysis were included in multivariate logistic regression.

Postoperative seroma developed in 48 patients (10.1%). In the univariate analysis, higher body mass index (BMI), recurrent hernia, bilateral hernia, scrotal hernia, longer operative time, and conversion to open surgery were significantly associated with seroma formation. In the multivariate analysis, scrotal hernia (OR 5.85; 95% CI 2.03-16.85; p = 0.001) and bilateral hernia (OR 1.67; 95% CI 1.09-2.55; p = 0.018) were identified as independent risk factors. Primary hernia was associated with a significantly lower risk of seroma formation (OR 0.342; 95% CI 0.159-0.732; p = 0.006), indicating that recurrent hernia represents an independent risk factor. BMI did not remain significant after adjustment.

Seroma formation after TEP repair is mainly driven by anatomical and technical factors. Scrotal hernia, bilateral repair, and recurrent hernia represent high-risk features and should be considered during preoperative risk assessment and perioperative planning.