Closure of a direct inguinal hernia defect in laparoscopic repair with barbed suture: a simple method to prevent seroma formation?

Purpose Seroma is a frequent postoperative complication after laparoscopic direct inguinal hernia repair (both in TAPP and TEP). There are several methods to address this problem; however, these techniques are not without problems. The purpose of this study was to introduce and evaluate a new technique to address this problem. Methods This is a prospective study of consecutive patients. All patients diagnosed with direct inguinal hernias eligible for laparoscopic repair were included. A single surgeon performed all the included operations. During laparoscopic inguinal hernia repair (TAPP or TEP), we closed the direct hernia defect with barbed sutures around the transversalis fascia, inverted the apex of the attenuated transversalis fascia, and sutured it at the base to completely eradicate the defect cavity. Prosthetic mesh was not additionally fixed in all patients. The primary postoperative outcome parameter was seroma formation, and secondary outcome parameters included groin pain, surgical complications, and hernia recurrence. Results Twenty-five male patients with 36 sides of direct hernias were included in this study, and all procedures were carried out laparoscopically and successfully. Only one patient developed significant seroma, which resolved 1 month later. The early postoperative pain was minimal, and no recurrence and chronic pain occurred during the follow-up period (4-13 months). Conclusions The present direct inguinal hernia defect closing technique with barbed suture is a simple, easily reproducible, and effective method for the prevention of seroma formation.