To investigate the clinical efficacy of laparoscopic closure of internal ring combined with mesh repair for type Ⅲ indirect inguinal hernia.

In this prospective randomized controlled study, 193 patients with type Ⅲ indirect inguinal hernia admitted to Nanchong Central Hospital Affiliated to North Sichuan Medical College from May 2020 to December 2021 were randomly divided into the experimental group (close internal ring, 93 cases) and the control group (not close internal ring, 100 cases). The operation time, postoperative hospital stays, postoperative pain visual analogue scale (VAS) score, seroma and seroma fluid volume, hospitalization cost, complications and recurrence were compared between the two groups.

The incidence of seroma in the experimental group was lower than that in the control group on the 7 d [32(34.4%) vs 63 (63.0%)], 14 d [16(17.2%) vs 35 (35.0%)], 21 d [6(6.5%) vs 20 (20.0%)] after operation, and the difference was statistically significant (P<0.01). The seroma fluid volume in the control group was higher than that in the experimental group on the 7 d [(36.44±16.57) ml vs (45.44±15.27) ml] and 14 d [(23.88±9.20) ml vs (32.23±8.87) ml] days after operation, and the difference was statistically significant (P<0.05). The number of patients with pain in the control group was significantly higher than that in the experimental group at 7 d [39(41.9%) vs 60(60.0%)]、14 d [17(18.2%) vs 33(33.0%)]、21 d [6(6.4%) vs 22(22.0%)] after operation, and the difference between the two groups was statistically significant (P<0.05). The VAS score in the control group was higher than that in the experimental group at 7 d [(1.95±0.71) points vs (2.37±0.62) points] and 14 d [(1.65±0.49) points vs (2.12±0.49) points] after operation, and the difference between the two groups was statistically significant (P<0.05). The operation time in the experimental group was longer than that in the control group [(64.1±12.1) min vs (54.9±9.7) min], and the difference was statistically significant (P<0.05). There was no significant difference between the two groups in the length of stay, total hospitalization cost and incidence of postoperative complications (urinary retention, intestinal obstruction, nausea, vomiting, bleeding and infection) (P>0.05). The postoperative follow-up time ranged from 3 to 20 months. No chronic pain or recurrence occurred in both groups during the postoperative follow-up.

Laparoscopic closure of the internal ring defect of type Ⅲ indirect hernia is safe and effective, which can significantly reduce the incidence of postoperative seroma and further reduce postoperative pain without increasing the risk of postoperative infection and recurrence.