title: Laparoscopic repair of direct inguinal hernia: a new technique that reduces the development of postoperative seroma.
abstract: BACKGROUND
  Seroma are common early postoperative complications encountered in laparoscopic inguinal hernia repair. Previous anecdotal evidence from our surgical practice suggested a lower incidence of postoperative seroma formation with direct hernia repairs when the lax transversalis fascia (TF) is inverted by tacking to the pubic ramus. We undertook a study to investigate whether TF inversion in this way reduces the incidence of postoperative seroma.
  
  
  METHODS
  A total of 216 patients undergoing transabdominal preperitoneal (TAPP) laparoscopic inguinal hernia repairs from August 2003 to December 2005 were included in this prospective non-randomised controlled study. Surgeon 1 would routinely invert the TF whereas surgeon 2 would not. At follow-up the presence of postoperative seroma and pain was recorded.
  
  
  RESULTS
  Mann-Whitney U test demonstrated no significant difference in terms of age, sex and time to follow-up between the surgeons' patient groups (P > 0.05), and Chi-square test demonstrated significantly that inversion of the TF is associated with a lower incidence of postoperative seroma (P < 0.05). There was no significant difference in terms of postoperative pain at follow-up.
  
  
  CONCLUSIONS
  Inversion of the TF is associated with a statistically lower incidence of postoperative seroma, without increasing postoperative pain despite the use of one or two additional tacks.
authors.affiliation: Department of General Surgery, Leicester Royal Infirmary, Infirmary Square, Leicester, LE1 5WW, UK. vmreddy@doctors.net.uk
authors.forename: V M
authors.initials: VM
authors.lastname: Reddy
authors.forename: C D
authors.initials: CD
authors.lastname: Sutton
authors.forename: L
authors.initials: L
authors.lastname: Bloxham
authors.forename: G
authors.initials: G
authors.lastname: Garcea
authors.forename: S S
authors.initials: SS
authors.lastname: Ubhi
authors.forename: G S
authors.initials: GS
authors.lastname: Robertson
mesh_terms: D034861:Abdominal Wall / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000071938:Fasciotomy; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011630:Pubic Bone / Q000601:surgery; D049291:Seroma / Q000209:etiology / Q000517:prevention & control*; D013536:Suture Techniques; D016896:Treatment Outcome