Primary Abandonment of the Sac in Minimally Invasive Surgery Inguinoscrotal Hernia Repairs: 1-Year Seroma Incidence and Long-Term Impact

Abstract

Introduction:

Inguinoscrotal hernia (ISH) hernias pose higher risk of complications. Traditionally, complete dissection of the hernia sac has been considered the standard approach but, more recently, primary abandonment of the sac (PAS) has emerged as simpler alternative and potentially reduced complications. Seromas are common postoperatively, but their association with sac abandonment remains debatable.

Objective:

To evaluate the long-term impact of PAS in minimally invasive ISH repairs.

Methods:

A total of 29 patients, in a prospective observational study, who underwent minimally invasive IHS repair with PAS technique were included. ISH was defined as hernia sac longer than 7 cm from the deep inguinal annulus. Primary outcome was seroma incidence and its impact in at least 1 year follow-up.

Results:

Seroma was observed in 62.1% of patients at 7 days, decreasing to 31.0% at 30 days, 10.3% at 90 days, 6.9% at 6 months, and 3.4% at 12 months. No drainage procedure was required. One patient developed ischemic orchitis, and no postoperative hematoma or recurrence was observed. Patients with longer hernia sacs had a significantly higher risk of seroma, particularly those with sacs over 10 cm. L3 hernia classification was also associated with increased seroma rates compared with L2. No other patient-related or surgical factors were linked to seroma risk.

Conclusions:

Since seroma is usually an acute postoperative complication, 1 year of follow-up may be considered adequate for this outcome. Despite a higher early seroma rate, most resolved spontaneously within 3 months, and none required intervention. PAS does not increase long-term seroma risk and may represent a simple and promising alternative for ISH repair.