Page 55 - World Journal of Laparoscopic Surgery

CASE REPORT
Post-transabdominal Preperitoneal Mesh Hernioplasty Seroma

Formation and Its Management: A Case Report

1
2
Jayanta Kumar Biswal , Sujit Kumar Mohanty , Bikash Ranjan Mishra 3
Received on: 18 March 2023; Accepted on: 04 June 2023; Published on: 05 September 2023
AbstrAct
Repair of inguinal hernia is one of the commonest surgical procedures performed worldwide. Starting from Bassini’s repair proposed in 1887,
numerous methods and their modifications have overwhelmed the field of inguinal hernia surgery and after the introduction of laparoscopy
there has been a procedural revolution for the same. Ger documented the first laparoscopic hernia repair in 1982 by approximating the internal
ring with stainless clips. Since then, transabdominal preperitoneal and total extraperitoneal hernia repair have become increasingly popular with
lesser postoperative pain, postoperative complications, early return to work, and less recurrence. However, when we talk about hernia repair, there
is tissue handling and this tissue manipulation gives rise to seroma formation which is one of the most common postoperative complications.
Keywords: Case report, Laparoscopic hernia repair, Open mesh repair (open), Polypropylene mesh, Scrotal mass, Seroma, Surgery, Transabdominal
preperitoneal, Total extraperitoneal, Unilateral inguinoscrotal hernia.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1559

IntroductIon 1–3 Department of General Surgery, SCB Medical College, Cuttack,
Seroma is a mass or a lump caused by a build-up of clear fluid in Odisha, India
a tissue, organ, or body cavity. It is often naturally resolving but Corresponding Author: Bikash Ranjan Mishra, Department of General
in certain cases, it persists which is misinterpreted as a recurr- Surgery, SCB Medical College and Hospital, Cuttack, Odisha, India,
ence of hernia by the patient leading to repeated visits of the Phone: +91 8763608377, e-mail: Bikashranjanmishra100@gmail.com
patient to outpatient as well as anxiety. Seroma usually occurs in How to cite this article: Biswal JK, Mohanty SK, Mishra BR. Post-
large inguinoscrotal hernias. 1–4 A remaining hernial sac during transabdominal Preperitoneal Mesh Hernioplasty Seroma Formation
transabdominal preperitoneal (TAPP) most often than not results and its Management: A Case Report. World J Lap Surg 2023;16(1):54–56.
in seroma formation. Source of support: Nil
Also, the dissection of two layers of fascia transversalis in the Conflict of interest: None
initial step of TAPP may result in local inflammation, which on a Patient consent statement: The author(s) have obtained written
later stage forms a seroma. The occurrence of seromas is common informed consent from the patient for publication of the case report
5
after large hernia and direct hernia repair. In the early phases of a details and related images.
learning curve in surgery, the chances of formation of a seroma is
very high, but with an increasing acquaintance with the procedure,
in experienced hands, the chances go significantly lower.
So aspiration of seromal fluid was planned and approximately 50 mL
of straw-colored fluid aspirated out. After aspiration, the swelling
cAse descrIptIon reduced in size greatly. The patient again presented with recurrent
A 43-year-old man presented to the surgery outpatient department swelling 15 days later. Repeat aspiration done for the second
(OPD) with a left-sided indirect complete inguinoscrotal hernia time. A subsequent visit after 15 days revealed a similar fluctuant,
for which TAPP was done. In the process of laparoscopic surgery, globular, discrete swelling, which was palpated separately from
we had left the distal sac intact. The patient again presented to chord structures. Finally, putting the patient’s comfort and desire
surgery outpatient department (SOPD) 15 days postoperative in the forefront excision of an entire sac of seroma along with its
with a left-sided scrotal swelling which was globular in shape, fluid content was planned, and the patient was admitted to the
with well-defined margins, size of approximately 6 cm × 5 cm, soft general surgery ward.
in consistency, fluctuant, and irreducible in nature. There was no A left scrotal incision was given to open skin subcutaneous
pain or tenderness associated with the swelling. Getting above the tissue and fascial layers.
swelling was positive. Testis and chord structures were palpated The seroma sac was identified and separated from the left testis
separately. The transillumination test was positive. and cod structures (Fig. 1).
The patient was sent for ultrasonography of the bilateral The sac was excised in toto (Fig. 2).
inguinoscrotal region, and the report suggested of cystic swelling The testis and cord structures were repositioned back in the
on the left side. All other routine serum investigations and blood scrotum and all the layers along with the skin closed. The sac
parameters were within normal limits. was then opened in a kidney tray and approximately 80 mL of
He was initially subjected to observation and oral antibiotics for hemorrhagic fluid came out. The sac was sent for histopathological
2 months. The swelling persisted even after 2 months postoperative. study (Fig. 3).

© The Author(s). 2023 Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.
org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to
the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain
Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.