Seroma following endoscopic extraperitoneal inguinal hernioplasty - Incidence and risk factors

Background: Because it mimics a postoperative recurrence of hernia, seroma has been a concern to patients. There has been no consensus on the management of this condition after endoscopic totally extraperitoneal inguinal hernioplasty (TEP). The objectives of the present study were to evaluate the incidence and treatment of seroma after TEP. Risk factors for the development of seroma were also examined. Methods: A total of 450 consecutive patients who underwent TEP between June 1999 and May 2002 were recruited. All data were collected prospectively. The outcomes of patients who developed seromas were compared to those without this postoperative complication. Regression analysis was performed to identify independent risk factors for seroma formation. Results: The overall incidence of seroma formation was 7.2% (n = 40). The postoperative recovery of patients was not influenced by the development of seroma. The mean size of the seromas was 3.8 cm. Adopted treatment strategies included observation (n = 29), oral lysozyme (n = 10), and percutaneous aspiration (n = 3), but neither of the two interventions appeared to be effective. The seromas resolved spontaneously by an average of 2.4 (mean) months. Significant clinical factors associated with seroma formation included old age, large hernial defects, an extension of the hernia into the scrotum, and the presence of a residual distal indirect sac. By logistic regression, a large hernial defect and an extension of the hernia into the scrotum were found to be independent risk factors for seroma formation. Conclusions: Although seroma is a frequent minor morbidity after TEP, it has no impact on postoperative recovery. Because all seromas invariably resolve, expectant treatment with observation is recommended. Inguinoscrotal hernia carries a four-fold increased risk of developing seroma after TEP.