Internal ring ligation in laparoscopic transabdominal preperitoneal repair of giant inguinoscrotal hernia: a non-prospective comparative study on seroma outcomes.

backgroundSeroma formation after laparoscopic transabdominal preperitoneal (TAPP) repair of giant scrotal hernia is thought to be associated with persistent dead space at the internal ring. Whether adjunctive internal ring ligation reduces postoperative seroma burden has not been prospectively evaluated.

methodsIn this prospective comparative study, 60 adult males with giant inguinoscrotal hernia were allocated according to the operative period to standard TAPP repair or TAPP with internal ring ligation. The primary endpoint was ultrasound-measured seroma volume at 1 month. A multivariable regression model for log-transformed outcomes was adjusted for preoperative hernia volume and internal ring diameter. Associations between residual ring caliber and seroma trajectory were assessed using Spearman correlation and linear mixed-effects modeling.

resultsAt 1 month, seroma volume was significantly lower in the ligation group (4.2 mL vs. 32.2 mL; P < 0.001). After adjustment, internal ring ligation remained independently associated with a lower geometric mean seroma volume (GMR 0.12; P < 0.001). Residual internal ring caliber correlated positively with seroma volume at 7 days, 1-month, 3-month (r = 0.60-0.70, all P < 0.001), and was associated with differences in longitudinal resolution trajectories (interaction P = 0.022). However, secondary clinical endpoints, including seroma aspiration rates, postoperative pain scores, and overall complication rates, did not reach statistical significance between groups.

conclusionsInternal ring ligation during TAPP repair was associated with reduced postoperative seroma burden and favorable seroma resolution trajectory in patients with giant inguinoscrotal hernia, without an evident increase in morbidity when followed up for 1 year.