Page 26 - World Journal of Laparoscopic Surgery

Postoperative Seroma Collection in Operated Case of TAPP Hernioplasty in Unilateral Inguinoscrotal Hernia

AIms And objectIves examination. Among three patients, two were operated upon for
To evaluate the incidence of postoperative seroma collection in TAPP an indirect hernia and the other one was treated for a direct hernia
(Table 1).
hernioplasty in inguinoscrotal hernia in our surgical department at All three patients were given chemotherapy (Seratopeptidase
AMC MET Medical College and LG hospital, Ahmedabad.
and Chymotrypsin tablets) and scrotal support was continued. In
one of the patients with a direct hernia, seroma collection was
mAterIAls And methods resolved postoperatively on day 7. Another patient of indirect
In this prospective observational study, 50 patients were randomly hernia, seroma collection was resolved on day 6 postoperatively,
selected from LG. General Hospital, AMC MET Medical College, and the third patient after 30 days by postoperatively.
Ahmedabad, India from May 2018 to May 2019. Moreover, 47 (94% ) patients felt only slight pain the next
morning after the operation, the pain became minimal 7 days
Inclusion Criteria later, and no chronic pain or neurological pain was recorded.
• Unilateral inguinoscrotal hernia going beyond the root of the All patients without complications were discharged. During the
scrotum in patients admitted to the Department of Surgery. follow-up period (1–12 months), no pain, seroma, and recurrence
• Patients who were willing to give informed consent for were reported by the discharged patients (Fig. 1).
laparoscopic TAPP hernioplasty repair.
Exclusion Criteria
• Patient’s age >65 years. Table 1: Development of seroma in direct and indirect hernia repair
by TAPP
• Patient’s age <18 years.
• Laparoscopic TAPP converted to open hernioplasty. Direct Indirect
• Inguinal hernia. inguinoscortal inguinoscrotal Total (N = 50)
hernia
hernia
All patients went through TAPP hernioplasty for an No. of operated
inguinoscrotal hernia after a complete explanation of conversion cases 6 (12%) 44 (88%) 50 (100%)
to open as well as postoperative seroma formation; which is usually Seroma
5–25%. Gentle careful dissection and perfect hemostasis were development 1 (2%) 2 (4%) 3 (6%)
attempted. The pseudosac was tacked toward the pubic bone
with two or three tacks in a large direct hernia to avoid seroma
formation. In indirect hernia, meticulous dissection was done at
the deep inguinal ring to skeletonize the sac from cord structures.
Nontraumatic graspers were used to dissect the planes to keep
the dissection field blood-free. We did not invert or dissect out
the whole distal sac in the indirect inguinoscrotal hernia. Instead,
the distal sac was left intact in place without closing the proximal
end of the distal sac. The lower edge of the distal sac was lifted and
fixed to the posterior abdominal wall in the site lateral and cranial
to the internal ring. The scrotum was to be completely deflated
before taking the ports out. Scrotal support was applied for the first
48 hours to prevent their formation. There is a need to reassure a
patient regarding the time-bound self-resolution of the swelling.
Though it may not resolve in 8 weeks, it might be aspirated under
aseptic precautions.
Since all cases were indoor patients, they were initially
reviewed the next day morning after the operation and the next
examination time point was 7 days later for seroma development
in OPD clinics. All patients were advised to return to the clinic
in case of delayed complications or any unexpected problems, Fig. 1: Development of seroma in direct and indirect hernia repair by
especially chronic pain and groin swelling. All the patients were TAPP (N = 50)
followed up at 6 weeks for recurrence (any cough impulse) or any
other complication. Then they are instructed to follow up every
month for 6 months. dIscussIon
Several kinds of procedures have been described in the literature
results to address the problem of seroma formation, including the use
A total of 50 operated cases of unilateral laparoscopic TAPP of external compression, the application of fibrin sealant in the
6
inguinoscrotal hernioplasty were included in the study. preperitoneal space, and dwelling a closed-suction drain in the
7
Out of 50 patients, 44 (88%) patients were operated on for preperitoneal space. Furthermore, the placement of drainage was
indirect inguinoscrotal and 6 (12%) patients were operated on for with a potential risk of iatrogenic infection and could only be placed
a direct inguinoscrotal hernia. for a short period. The pressure dressing is usually difficult to apply
Only three (6%) patients developed clinically detectable seroma over the groin region. Nevertheless, the optimal management of
during the follow-up period (pod-2), as revealed by their physical the distal sac is still debated, though some studies have supported

24 World Journal of Laparoscopic Surgery, Volume 14 Issue 1 (January–April 2021)