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Hydrodissection in transabdominal preperitoneal repair for indirect inguinal hernia: A randomized controlled trial
1Department of General Surgery, West China School of Medicine, Sichuan University, Sichuan University Affiliated Chengdu Second People's Hospital, Chengdu Second People's Hospital, Chengdu, Sichuan, Sichuan, 610017, China. BJ_227688@126.com.
Objective:
Inguinal hernia, a common surgical condition, is preferably managed via transabdominal preperitoneal laparoscopic hernia repair (TAPP) ; however, indirect hernia sac management remains challenging. This randomized controlled trial aimed to assess the efficacy of hydrodissection in reducing seroma incidence and improving perioperative outcomes during TAPP repair for indirect inguinal hernia.
Methods:
A prospective, single-blinded randomized controlled trial enrolled 128 male patients, randomized 1:1 to hydrodissection or conventional dissection. The hydrodissection technique involved injecting 10 mL of normal saline into the preperitoneal space on the medial and lateral sides of the internal inguinal ring under laparoscopic guidance, creating a circular fluid distribution to facilitate dissection while avoiding critical structures. Primary outcome was seroma incidence at follow-up; secondary outcomes included operation time and chronic pain. Analyses followed intention-to-treat principles.
Results:
The median follow-up duration was 14 months. Hydrodissection demonstrated significant reductions in seroma formation (4.69% vs. 15.63%, P = 0.041) and operation time (28.22 ± 4.65 vs. 31.61 ± 6.78 min, P = 0.001) compared with conventional dissection. No significant differences were observed in intraoperative blood loss, hernia sac transection rate, postoperative hospitalization duration, time to first flatus, or total medical costs from surgery to discharge (all P > 0.05). Notably, the cohort reported zero perioperative complications, postoperative adverse events, conversions to open surgery, or unplanned readmissions during follow-up.
Conclusion:
Hydrodissection in TAPP repair safely reduces seroma risk and operative time, offering a promising option for indirect inguinal hernia. Larger multicenter trials are needed to confirm its routine use in standard surgical protocols.
Trial Registration:
ChiCTR2400080089 at Chictr.org.cn (January 19, 2024).