To investigate the clinical effect and application of hernia defect closure in the laparoscopic transabdominal preperitoneal (TAPP) direct inguinal hernia repair for the prevention of postoperative seroma formation.

A prospective randomized controlled study was conducted on 154 cases of direct inguinal hernia who underwent TAPP repair in Beijing Luhe hospital from January 2017 to December 2019. According to random grouping method, the patients were randomly assigned into the experimental group (closed defect group, closed and fixed transverse fascia to Cooper's ligament or lower edge of the rectus abdominis and tough tissue of abdominal wall, or only "cross" mattress suture of the transverse fascia) and control group (did not close the defect, separated the "false" hernial sac without any intervention). Compared two groups of patients with operation parameters and surgery related complications. In addition, the incidence of postoperative seroma in the two groups were examined by ultrasound and analyzed.

In terms of operation-related indicators, the operative time of the experimental group and the control group was (52.34±11.29) minutes vs (46.33±7.96) minutes, respectively, and the difference between the two groups was statistically significant (P<0.05). There were no statistically significant differences in the intraoperative and preoperative complications between the two groups (P>0.05). In terms of seroma, the range of postoperative seroma in the experimental group and the control group was (3.65±1.50) cm vs (5.14±1.77) cm, and (2.66±1.24) cm vs (3.51±1.36) cm, respectively, on the 1st day and 7th day after surgery. The differences between the two groups were statistically significant. In the follow-up period, the seroma incidence of the experimental group and the control group at 1 month and 3 months after surgery was 12.99% vs 28.57% and 2.60% vs 5.19%, respectively. The seroma incidence of the experimental group was also significantly lower than that of the control group, with statistical significance (P<0.05).

In laparoscopic transabdominal preperitoneal direct inguinal hernia repair, the closure of direct hernia defect by suturing the transverse fascia can effectively reduce the incidence of postoperative seroma. Although the operation time is increased, it is safe and effective, especially for large direct hernia.