title: Early postoperative evaluation of groins after laparoscopic total extraperitoneal repair of inguinal hernias.
abstract: BACKGROUND
  Minimally invasive laparoscopic total extraperitoneal (LTEP) repair of bilateral and/or recurrent groin hernias has been popularized as one of the procedures of choice in the past decade. The early postoperative course is uneventful in most cases. A few patients, however, will develop temporary postoperative groin swelling. The aim of our study was to evaluate clinical and sonographic findings in the groin during the early postoperative period following LTEP.
  
  
  METHODS
  One hundred and five consecutive patients with primary bilateral (n = 90), recurrent unilateral (n = 12), and primary unilateral (n =3) groin hernias operated on during an 18-month period underwent clinical and sonographic examination two to three weeks after LTEP.
  
  
  RESULTS
  On clinical examination, a localized groin swelling was found in 21 patients (20%). The most frequent sonographic findings were localized groin collections compatible with seroma or hematoma, found in 35 patients (33%). Hypoechoic diffuse tissue swelling around the mesh, lipomas, and residual hernias was found in four patients each (4%). None of the patients with hypoecoic mass had any clinical manifestations postoperatively. Extraperitoneal close suction drains were left for 8-12 hours in 46 patients. The average volume of fluid drained was 62 mL (range, 30-200 mL). There was no correlation between the use of suction drains and the frequency of fluid collections detected on sonography. Cord lipoma was detected postoperatively in four patients and was excised in one using an open anterior approach. Residual or recurrent hernia was detected postoperatively on sonography in four patients, but only one developed a symptomatic and clinically detectable hernia during eight months of follow-up. Overall, postoperative ultrasonographic findings following LTEP repair were found in 37% of patients.
  
  
  CONCLUSIONS
  Clinical and sonographic findings such as localized fluid collections compatible with seroma or hematoma are common following LTEP. Postoperative suction drains did not reduce the frequency of sonographically detected collections. The clinical relevance of suspected postoperative hernia detected on sonography without clinical manifestations remains uncertain, and has to be determined on long-term follow-up.
authors.affiliation: Departments of Surgery and Radiology, Meir General Hospital, Kfar Sava, Israel. shpitzca@post.tau.ac.il
authors.forename: Baruch
authors.initials: B
authors.lastname: Shpitz
authors.forename: Josef
authors.initials: J
authors.lastname: Kuriansky
authors.forename: Miriam
authors.initials: M
authors.lastname: Werener
authors.forename: Alexandra
authors.initials: A
authors.lastname: Osadchi
authors.forename: Vitaly
authors.initials: V
authors.lastname: Tiomkin
authors.forename: Nikolay
authors.initials: N
authors.lastname: Bugayev
authors.forename: Ehud
authors.initials: E
authors.lastname: Klein
mesh_terms: D005260:Female; D006119:Groin / Q000000981:diagnostic imaging*; D006406:Hematoma / Q000000981:diagnostic imaging; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011184:Postoperative Period; D049291:Seroma / Q000000981:diagnostic imaging; D014463:Ultrasonography