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Effect of closing the internal ring during laparoscopic TAPP for Nyhus type III indirect inguinal hernia on
Dan Li1, Hui Zhang1, Hui Wang1
1Department of General Surgery, Guangdong Provincial People's Hospital, Zhuhai Hospital (Jinwan Central Hospital of Zhuhai), Zhuhai, Guangdong, China.
Objective:
To investigate whether sutured closure of the internal ring during laparoscopic transabdominal preperitoneal patch plasty (TAPP) reduces postoperative seroma formation in patients with Nyhus type III indirect inguinal hernia.
Methods:
We retrospectively analyzed clinical data from 266 male patients who underwent surgery for unilateral primary Nyhus type III indirect inguinal hernia between January 2022 and December 2025. Patients were stratified into an experimental group (n = 133, intraoperative internal ring closure) and a control group (n = 133, no internal ring closure) according to whether surgeons performed internal ring suturing during operation. Baseline demographics, maximum internal ring defect diameter, 24 h postoperative Visual Analogue Scale (VAS) pain score, operative duration, intraoperative blood loss, length of postoperative hospital stay, seroma incidence, hernia recurrence rate, and other complications were compared between the two cohorts.
Results:
Baseline characteristics were balanced between the two groups (all P > 0.05). Operative duration was significantly longer in the experimental group compared with the control group [(56.84 ± 7.80) min vs. (54.66 ± 7.88) min, P = 0.02]. No significant intergroup differences were detected in intraoperative blood loss, 24 h postoperative VAS score, or postoperative hospital stay (all P > 0.05). The incidence of postoperative seroma was markedly lower in the experimental group than in the control group [2.30% (3/133) vs. 9.02% (12/133), P = 0.03]. Two hernia recurrences were observed exclusively in the control group [1.50% (2/133) vs. 0.00% (0/133), P = 0.50]; however, the short follow-up duration precluded any definitive conclusions about intergroup differences in recurrence risk. No other severe complications occurred in either group.
Conclusion:
Intraoperative internal ring closure is a safe and feasible adjunct to TAPP for Nyhus type III indirect inguinal hernia, only slightly prolonging operative duration. This technique lowers the risk of early postoperative seroma, yet long-term recurrence outcomes remain to be validated in larger cohorts with extended follow-up.