A Comparative Study on Effects of Defect Closure versus Non-Closure in Laparoscopic Totally Extraperitoneal Repair of Direct Inguinal Hernia

Abstract

Background:

Seroma formation is a common postoperative complication following laparoscopic Totally Extraperitoneal (TEP) repair, particularly in moderate-to-large direct inguinal hernias. Defect closure may reduce dead space and thereby decrease seroma formation, but evidence remains inconclusive.

Objective:

To compare the outcomes of defect closure versus non-closure in laparoscopic TEP repair of large direct inguinal hernia with respect to seroma formation, pain, intraoperative characteristics, and postoperative recovery.

Methods:

This retrospective cohort study was conducted at Chettinad Hospital and Research Institute from June 2024 to July 2025. A total of 40 adults with uncomplicated direct inguinal hernias (M3 or larger, EHS classification) underwent laparoscopic TEP repair and were divided into defect closure (n=20) and non-closure (n=20) groups. Primary outcomes were seroma formation and postoperative pain (VAS score). Secondary outcomes included operative time, intraoperative complications, hospital stay, return to normal activity, and recurrence. Data were analyzed using SPSS, and p <0.05 was considered statistically significant.

Results:

Baseline demographic parameters were comparable between the two groups. Mean operative time was longer in the defect closure group (62.4 ± 8.1 min) compared to the non-closure group (55.6 ± 7.4 min), but the difference was not statistically significant (p=0.070). Intraoperative complications were comparable between groups. Seroma formation at the 10th postoperative day was noted in 25% of patients in the defect closure group and 35% in the non-closure group (p=0.521). At one month follow-up, seroma reduced to 10% and 15% respectively (p=0.633). Univariate analysis showed operative time ≥60 minutes was significantly associated with increased seroma formation (OR = 4.44, 95% CI: 1.07–18.3; p = 0.045).

Conclusion:

Defect closure during laparoscopic TEP repair of large direct inguinal hernia is safe and feasible, with comparable intraoperative and postoperative outcomes to non-closure. Defect closure demonstrated a lower tendency for early seroma formation, while longer operative duration was significantly associated with increased seroma risk. Further large-scale prospective studies with longer follow-up are recommended.