Non-closure of the Free Peritoneal Flap During Laparoscopic Hernia Repair of Lower Abdominal Marginal Hernia: A Retrospective Analysis

The Relationship Between Small Peritoneal Flap Defects and Postoperative Seroma in TAPP Repair of Inguinal Hernias

OBJECTIVE

Total abdominal preperitoneal (TAPP) is one of the most frequently used surgical treatment methods in the treatment of inguinal hernia (IH). One of the most common early postoperative complications after hernia repair is seroma/hematoma. In this study, we aimed to study the role of unclosed peritoneal flap defects on the development of postoperative seroma.

MATERIAL AND METHODS

The study was performed retrospectively in 2 university hospitals. All patients over the age of 18 years who underwent laparoscopic TAPP surgery in Istanbul Yeni Yüzyıl University Gaziosmanpaşa Hospital General Surgery Clinic and Van Yüzüncü Yıl University Faculty of Medicine General Surgery Clinic between January 1, 2018, and December 31, 2021, were included. Patients were divided into those with peritoneal defects (group 1) and those without (group 2). Whether there was a peritoneal defect or not was compiled from video recordings. In addition, risk factors affecting the development of seroma were determined.

RESULTS

A total of 250 patients, 16 (6.4%) women and 234 (93.6%) men, were included in the study. There were bilateral hernias in 35 (14%) patients, and a total of 320 hernias were analyzed in the study. It was determined that an American Society of Anaesthesiologists (ASA) III score increased the risk of seroma 15.97 fold (P<0.001, 95% CI, 4.94 to 51.56), direct hernia type increased risk 7.1 fold (P<0.03, 95% CI, 1.204 to 42.422), hernia descending into scrotum increased risk 22.48 fold (P<0.001, 95% CI, 6.66 to 75.84) and closure of the peritoneal flap completely without leaving any defect increased the risk of seroma 8.67 fold (P<0.001, 95% CI, 3.254 to 23.115).

CONCLUSIONS

The presence or leaving of small-diameter defects on the peritoneal flap may reduce seroma development without increasing the risk of complications. Prospective randomized studies are required to reach definitive conclusions.

Laparoscopic repair of suprapubic incisional hernia using a modified transabdominal partial extraperitoneal technique

INTRODUCTION

Herein, we describe a novel technique for suprapubic incisional hernia repair using a modified transabdominal partial extraperitoneal technique in four patients.

MATERIALS AND SURGICAL TECHNIQUE

We implemented four-trocar placement to achieve a coaxial setting for the pubic bone. The pubic bone and Cooper's ligament were exposed by an incision dorsal to the hernial orifice, and the bladder was mobilized as an inferior peritoneal flap. The retropubic space was dissected approximately 5 cm from the hernial defect and this was closed with an intracorporeal non-absorbable barbed suture. A mesh was introduced into the intra-abdominal cavity, positioned to cover the closed defect, and tied to Cooper's ligament, the pubic bone, and rectus muscles. The dissected peritoneal flap was reattached to the abdominal wall by tacking and suturing.

DISCUSSION

The modified transabdominal partial extraperitoneal technique for suprapubic incisional hernia repair may contribute to decreased recurrence and seroma formation.