Primary abandon of hernia sac for inguinoscrotal hernias: a safe way to cut corners

• Published in: Surgical endoscopy Vol. 37; no. 11; pp. 8421 - 8428
• Main Authors: Claus, Christiano, Malcher, Flavio, Trauczynski, Pedro, Morrell, Alexander Charles, Morrell, Andre Luiz Gioia, Furtado, Marcelo, Ruggeri, João Rafael Bora, Lima, Diego L., Cavazzola, Leandro Totti
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-11-2023; Springer Nature B.V
• Subjects: Abdominal Surgery; Dissection; Endoscopy; Gastroenterology; Gynecology; Hematoma; Hepatology; Hernia, Inguinal - complications; Hernia, Inguinal - surgery; Hernias; Herniorrhaphy - methods; Hospitals; Humans; Ischemia; Laparoscopy; Laparoscopy - methods; Male; Medicine; Medicine & Public Health; Patients; Postoperative Complications - epidemiology; Postoperative Complications - etiology; Postoperative Complications - surgery; Proctology; Regression analysis; Robotics; Seroma - epidemiology; Seroma - etiology; Surgeons; Surgery; Surgical Mesh - adverse effects; Inguinal hernia; Minimally invasive surgery; Abandon the sac
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-023-10416-z

Introduction
Inguinoscrotal hernias (ISH) pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence rates. The aim of this study is to report our initial experience and early results with a new technique for inguinoscrotal hernia repair.
Methods
A review of a prospectively maintained multi-center database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias from March 2021 to July 2022. Demographics and outcomes were analyzed. Univariate analysis and multivariate logistic regression were performed.
Results
A total of 76 minimally invasive inguinal hernia repairs were performed. In 70 patients (92%) C-PAS was used as the technique to abandon the sac while in the remaining 6 patients, "pirate-eye-patch" technique was used. Median hernia ring was 3 (IQR 2.5–3.5) cm and median hernia sac was 9.5 (8–10.8) cm. Median operative time was 70 min (IQR 56–96). Seroma was present in 22 (28.9%) patients 7 days after surgery. Most had seroma only in the inguinal area (
n
 = 19; 25%). Thirty days after surgery, 12 (15.8%) patients still had seroma in the inguinal area and 6 (7.9%) in the inguinoscrotal area. Ninety days after surgery, four (5.3%) patients had inguinal seroma, 2 (2.6%) scrotal seromas and 3 (3.9%) inguinoscrotal seromas. The size of the hernia sac was not associated with seroma formation 7 days after surgery (OR 1.06; 95% CI 0.89–1.2;
P
 = 0.461) in the multivariate logistic regression. BMI was also not associated with seroma formation (OR 0.8; 95% CI 0.74–1.06;
P
 = 0.2).
Conclusions
Planned abandon of the hernia sac is an interesting alternative and is associated with a low rate of complications and acceptable seroma formation rates.