The application of internal ring closure in laparoscopic transabdominal preperitoneal (TAPP) repair for large indirect inguinal hernias: a retrospective study of 162 cases

PURPOSE: Patients with primary unilateral indirect inguinal hernias and large internal inguinal rings have a higher incidence of seroma formation following laparoscopic transabdominal preperitoneal (TAPP) hernia repair. This study aims to investigate the clinical efficacy of suturing and closing the internal inguinal ring during the TAPP procedure to reduce the postoperative seroma rate. METHODS: A retrospective analysis was conducted on the clinical data of 162 patients with primary unilateral indirect inguinal hernias and an internal ring defect diameter of ≥ 3.0 cm, who were treated at Kunshan First People's Hospital from December 2023 to November 2024. All patients underwent the TAPP procedure with hernia sac transection. Based on whether the internal inguinal ring was sutured closed intraoperatively, patients were divided into two groups: an experimental group (internal ring closure, n = 81) and a control group (no internal ring closure, n = 81).The study compared the incidence of postoperative seromas, perioperative indicators (operative time, incision size, blood loss, length of hospital stay, etc.), and other related complications (postoperative pain, sensory abnormalities, infection, urinary retention, testicular edema, etc.) between the two groups, as well as short-term recurrence rates. RESULTS: There were no statistically significant differences in the baseline characteristics between the two groups, and all surgeries were completed successfully. The incidence of seroma in the experimental group at 7 days and 1 month postoperatively was significantly lower than in the control group [8.64% (7/81) vs. 28.40% (23/81), P = 0.002; and 2.47% (2/81) vs. 13.58% (11/81), P = 0.018, respectively]. Regarding severity (Morales-Conde classification), the experimental group recorded 5 Grade I and 2 Grade II cases, with zero Grade III events; whereas the control group observed 12 Grade I, 8 Grade II, and 3 Grade III events. There were no significant differences in seroma incidence between the two groups at 3 months and 6 months postoperatively (P > 0.05). The operative time for the experimental group [(63.67 ± 9.26) min] was slightly longer than that of the control group [(60.21 ± 10.23) min] (t = 2.255, P = 0.025). There were no statistically significant differences in other perioperative indicators, other related complications, or short-term recurrence rates between the two groups (P > 0.05). CONCLUSION: For primary unilateral indirect inguinal hernias with an internal ring defect diameter of ≥ 3.0 cm, suturing and closing the internal ring defect during the TAPP procedure was associated with a lower rate of seroma formation.