Ефект от зашиването на псевдосака към лигамента на Купър върху образуването на серома след лапароскопска тотална екстраперитонеална корекция на ингвинална херния

Абстракт

Abstract. Background: Seroma is a frequent early complication after laparoscopic inguinal hernia repair, often arising in the residual “pseudosac” created after sac reduction. Suturing this lax pseudosac to Cooper’s ligament has been proposed to reduce dead space and seroma formation, but comparative data in totally extraperitoneal (TEP) repair remain limited. Materials and Methods: This prospective single-centre randomized controlled trial was conducted over 30 months in adults undergoing laparoscopic TEP repair for symptomatic inguinal hernia. Forty patients were randomized 1:1 to TEP with pseudosac suturing to Cooper’s ligament (intervention) or standard TEP without suturing (control), all performed by a single surgeon. The primary outcome was seroma formation within 15 days. Secondary outcomes included postoperative pain on day 1 (VAS 0–10), duration of hospital stay, and wound infection at day 1 and 1 week. Results: Baseline demographic and clinical characteristics were comparable between groups. Seroma within 15 days occurred in 1/20 (5%) patients in the suturing group and 3/20 (15%) in the non-suturing group, yielding a 66.7% relative risk reduction, 10% absolute risk difference, and number needed to treat of 10; no seroma persisted beyond 15 days. Mean day-1 pain scores were low and similar (1.80 ± 1.74 vs 1.65 ± 1.73; p=0.72). Early discharge (2–3 days) was achieved in 95.0% of suturing patients versus 80.0% of controls. Two superficial surgical site infections (10%) occurred only in the non-suturing group, with no deep or organ-space infections. Conclusion: Suturing the pseudosac to Cooper’s ligament during laparoscopic TEP inguinal hernia repair confers a clinically meaningful reduction in early seroma formation, with comparable pain, low infection rates, and a trend toward earlier discharge. This simple, reproducible maneuver can be considered as an adjunct in TEP repair, particularly in patients at higher risk of seroma.