To determine whether internal ring closure following transverse sac transection during laparoscopic totally extraperitoneal (TEP) inguinal hernia repair is superior in reducing postoperative seroma incidence compared to transverse sac transection with distal sac abandonment or complete sac dissection.

From August 15, 2021, to September 15, 2023, participants were recruited from the Hernia and Abdominal Wall Surgery Department at Foshan First People's Hospital. Participants were randomly assigned in a 1:1:2 ratio to the closure group, abandonment group, or dissection group, respectively. Relevant data, including hospitalization records, follow-up records, surgical videos, and examination reports, were collected to analyze and compare the incidence of postoperative seroma, operation time, intraoperative blood loss, intraoperative bleeding events, postoperative pain scores, and other postoperative complications among the three groups.

A total of 454 participants were successfully enrolled. After excluding cases that involved intraoperative group crossover or loss to follow-up, 389 participants were included in the statistical analysis: 84 in the closure group, 82 in the abandonment group, and 223 in the dissection group. The overall incidence of postoperative seroma was 22.62% (88/389), with 26.2% (22/84) in the closure group, 29.3% (24/82) in the abandonment group, and 18.8% (42/223) in the dissection group. No statistically significant difference was found among the three groups (P=0.105). A stratified chi-square analysis of factors affecting seroma incidence (maximum sac diameter, intraoperative bleeding events, and intraoperative blood loss) showed that when the maximum sac diameter was ≥10 cm, the incidence of seroma in the dissection group was significantly higher than in the closure group (83.3% vs 31.1%, P=0.001). When intraoperative blood loss was >5 ml, the incidence of seroma in the abandonment group was significantly higher than in the closure group (90.0% vs 33.3%, P=0.036).

Each of the three sac management techniques has its own clinical applicability. There is no significant difference in the overall incidence of postoperative seroma among the techniques. Complete sac dissection is more effective for cases with a maximum sac diameter <10 cm, while internal ring closure is superior for reducing seroma incidence in cases with a maximum sac diameter ≥10 cm or intraoperative blood loss >5 ml.