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Postoperative Seroma Collection in Operated Case of TAPP Hernioplasty in Unilateral Inguinoscrotal Hernia
            the complete dissection of the sac to avoid seroma formation;  8,9   decrease the chance of the development of seroma in the unilateral
            however, this complete dissection may be difficult in certain cases   inguinoscrotal hernia.
            and carry the risk of injury to adjacent vasculature.
                       10
               Reddy et al.  reported a method of inversion and staple fixation   references
            of the lax transversalis fascia to Cooper’s ligament, which reduced
            the incidence of seroma formation after laparoscopic repair of       1.  Laparoscopic Trans Abdominal Pre-peritoneal (TAPP) Repair
                                                                    of Inguinal Hernia, World laparoscopic hospital, essential for
            direct inguinal hernia. However, these approaches did not apply   laparoscopic surgery, https://www.laparoscopyhospital.com/
            to the indirect hernia, since there is no lax transversalis fascia for   laparoscopic-tapp-inguinal-hernia.html.
            management in the indirect hernia. Interestingly, Daes reported a      2.  Köckerling F, Bittner R, Adolf D, et al.  Seroma following transabdominal
            method of pulling up the distal hernia sac out of the scrotum and   preperitoneal patch plasty (TAPP): incidence, risk factors, and preventive
            fixing it to the posterior abdominal and reported a low incidence of   measures. Surg Endosc 2018;32:2222–2231. DOI: 10.1007/s00464-017-5912-3.
            clinically significant seroma in indirect inguinoscrotal hernia repair. 11    3.  Leibl BJ, Schmedt CG, Kraft K, et al. Scrotal hernias: a contraindication
               Various incidences of seroma formation have been reported in   for an endoscopic procedure? Results of a single-institution
            the literature, and the increased frequency and volume of seroma   experience in transabdominal preperitoneal repair. Surg Endosc
                                                                    2000;14:289–292. DOI: 10.1007/s004640000045.
            formation were associated with large or inguinoscrotal hernias. Lau     4.  Misra MC, Bhowate PD, Bansal VK, et al. Massive scrotal hernias:
            and Lee reported a seroma rate of 5.7% in nonscrotal hernias and   problems and solutions. J Laparoendosc Adv Surg Tech A 2009;
            the rate increased to 22.9% in scrotal hernias following laparoscopic   19:19–22. DOI: doi.org/10.1089/lap.2008.0212.
                     8
            hernioplasty.  This finding differs from our result where postoperative     5.  Bringman S, Ramel S, Heikkinen TJ, et al. Tension-free inguinal hernia
            seroma collection was noted around six percentages.     repair: TEP versus mesh-plug versus Lichtenstein: a prospective
                                                                    randomized controlled trial. Ann Surg 2003;237(1):142–147.
                                                                    DOI:  10.1097/00000658-200301000-00020.
            conclusIon                                           6.  Sürgit Ö, Çavuşoğlu NT, Kılıç MÖ, et al. Use of fibrin glue in preventing
            In some cases of large scrotal hernia, the distal sac was difficult to   pseudo-recurrence after laparoscopic total extraperitoneal repair of
            be inversed or the hernia sac even adhered firmly to the ipsilateral   large indirect inguinal hernia. Ann Surg Treat Res 2016; 91(3):127–132.
                                                                    DOI: 10.4174/astr.2016.91.3.127.
            testicle and other structures. Besides, the use of Protack™ in the Daes      7.  Ismail M, Garg M, Rajagopal M, et al. Impact of the Closed-suction
            approach also significantly increases the whole cost of the hernia   Drain in Preperitoneal Space on the Incidence of Seroma Formation
            repair procedure. Thus, in this study, we did not invert the distal sac   after Laparoscopic Total Extraperitoneal Inguinal Hernia Repair. Surg
            but left the distal sac in place. Our method has the advantage that   Laparosc Endosc Percutan Tech 2009; 19(3):263–266. DOI: 10.1097/
            we can avoid dissecting out the distal sac. Since the potential space   SLE.0b013e3181a4d0e1.
            localized behind the mesh extending into the scrotum is one of the     8.  Lau H, Lee F. Seroma following endoscopic extraperitoneal inguinal
            main causes of the annoying seroma, our technique prevents the   hernioplasty. Surg Endosc 2003; 17(11):1773–1777. DOI: 10.1007/
            inflow of any exudation and fluid generated in the preperitoneal   s00464-002-8771-4.
            space during and after operation into the distal hernia sac in the     9.  Bittner R, Arregui ME, Bisgaard T, et al. Guidelines for laparoscopic
                                                                    (TAPP) and endoscopic (TEP) treatment of inguinal hernia
            scrotum. Furthermore, the distal hernia sac was not completely   [International Endohernia Society (IEHS)]. Surg Endosc 2011;
            closed, since the upper edge of the sac was not sutured, thereby   25(9):2773–2843. DOI: 10.1007/s00464-011-1799-6.
            preventing the potential fluid collection from the secretion of the     10.  Reddy VM, Sutton CD, Bloxham L, et al. Laparoscopic repair of direct
            distal sac itself. Another advantage of this method is that leaving   inguinal hernia: a new technique that reduces the development of
            the distal sac undissected minimized the risks of damage to the   postoperative seroma. Hernia 2007; 11(5):393–461. DOI: 10.1007/
                                                                    s10029-007-0233-4.
            cord structures.                                     11.  Daes  J.  Endoscopic  repair  of  large  inguinoscrotal  hernias:
               In our study, we observed less occurrence of the seroma.   management of the distal sac to avoid seroma formation. Hernia
            That suggests that the laparoscopic method can help prevent or   2014;18(1):119–122. DOI: 10.1007/s10029-012-1030-2.





























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