Effect of sac transection versus sac reduction on seroma in laparoscopic indirect hernia repair: a systematic review and meta-analysis

Seroma formation is a prevalent postoperative complication following laparoscopic inguinal hernia repair. While seromas are mostly self-absorbed, they can cause discomfort for the patient and complicate the assessment of hernia recurrence. Two primary techniques for managing the hernia sac are sac transection and complete sac reduction. This article aims to evaluate whether sac transection leads to a higher incidence of seroma compared to sac reduction and to review the main preventive strategies for seroma.

Four databases (PubMed, MEDLINE, Embase and Cochrane Library) and ClinicalTrials.gov were comprehensively searched for relevant studies. The date of the last search was 25 March 2024. The results reported should include reliable information on seroma incidence, mean operation time, hospital stay and postoperative complications.

The present study included 6 studies compared the results of indirect hernia sac transection and complete sac reduction. The pooled results indicated that indirect hernia sac transection was associated increased seroma formation (OR = 1.74, 95% CI: 1.35–2.24%), and there was no statistical difference in mean operation time, hospital stay and recurrence between the sac transection (TS) and sac reduction (RS) groups. Postoperative pain was evaluated in 4 studies. There was no statistical difference between the two groups in postoperative pain reported in each of the four articles.

The study revealed that transection of the indirect hernia sac is associated with a higher incidence of seroma, but does not increase the occurrence of other complications.