PREPERITONEAL SEROMAS FOLLOWING LAPAROSCOPIC TAPP HERNIOPLASTY: PATHOGENESIS, RISK FACTORS, AND OUTCOMES OF PROPHYLACTIC DRAINAGE

Abstract

Seroma formation within the preperitoneal space is one of the most frequent early complications of transabdominal preperitoneal (TAPP) hernioplasty, with reported incidence ranging from 3.8% to 12%. Its pathogenesis involves extensive dead-space creation during dissection, lymphatic disruption, peritoneal exudation, and a foreign-body response to prosthetic mesh. This retrospective comparative study (n = 176) evaluated the clinical efficacy of selective prophylactic preperitoneal drainage in high-risk patients. In the control group (n = 94, standard TAPP without mandatory drainage), clinically significant seromas occurred in 4 patients (4.3%), including one case requiring repeat laparoscopy (Clavien–Dindo IIIb). In the study group (n = 82, selective drainage in bilateral, large, or recurrent hernias), no clinically manifest seromas were recorded. Grade I complication rate decreased from 10.6% to 4.9%. Selective prophylactic drainage is a simple, effective, and low-cost measure to prevent clinically significant seroma formation in TAPP hernioplasty among high-risk patients.