To explore the feasibility of applying modified medical adhesive false hernia sac to prevent seroma after laparoscopic totally extra-peritoneal (TEP) direct hernia repair.

From April 2017 to May 2019, 36 patients with direct inguinal hernia admitted to Department of Hepatobiliary Hernia and Abdominal Wall Surgery of Xi'an Central Hospital were included. All patients underwent TEP hernia repair. Direct hernia false hernia sacs were given modified medical adhesive to prevent postoperative seroma.

There were 36 patients, including 31 males and 5 females. Patients aged 31~82 years, with an average age of 67.5 years. The body mass index ranged 17.6~31.5 kg/m², with an average body mass index of 24.6 kg/m². Among them, there were 13 cases of typeⅡ hernia and 23 cases of typeⅢ hernia, all of which were unilateral direct inguinal hernias. There were 25 cases of right hernia and 11 cases of left hernia. All the operations were successfully completed, there was no case converted to laparoscopic trans-abdominal preperitoneal hernia repair (TAPP), and no serious complications such as infection. The operation time ranged from 36.6 to 53.2 minutes, with an average time of 44.5 minutes. The peritoneum of one patient was ruptured when dissociating the outer edge of arcuate line, and 3-0 absorbable thread was sutured during the operation, leading to prolongation of operation time. Intraoperative bleeding was 1~5 ml, with an average of 3 ml. Patients got out of bed 24 to 36 hours after surgery, with an average time of 30 hours. Patients were discharged 1~3 days after surgery, with an average of 2 days. The hospitalization cost was 1135.42~1269.74 yuan, with an average of 1189.42 yuan. The postoperative visual simulation score (VAS) was used for evaluation. All patients had a VAS score of 2~5 at the first day after operation, with an average of 3.5. Among all patients, 2 cases had seroma at 1 week and 2 weeks after operation. The incidence of seroma was confirmed by inguinal B-ultrasound. The incidence of seroma was 5.56%. Seroma of one case disappeared spontaneously after 3 months of follow-up due to its small size and no special treatment. The other case was given partial fluids twice, it disappeared after 3 months. No other patients had obvious seroma.

The modified medical adhesive false hernia sac is a simple and easy-to-use technique to prevent seroma after TEP, with reliable effect, and worthy of promotion and further research.