Application of integral suture for medial hernia defect closure in eTEP hernioplasty for direct inguinal hernia

The OBJECTIVE was to evaluate the immediate and long-term results of integral suture application and to determine the indications for its use in eTEP hernioplasty for primary rectal inguinal hernia in men.
METHODS AND MATERIALS. A prospective single-center double-blind randomized controlled study on the basis of the City Clinical Hospital named after S. S. Yudin was conducted. The study included patients with the first-diagnosed direct inguinal hernias for eTEP hernioplasty with hernia gate size from 1.5 cm to 3 cm corresponding to MP2 according to EHS (2009). Patients were allocated to a comparison group with hernia defect closure and a control group using the ALEA randomization program. The following parameters were evaluated in patients: the presence of seroma on the 1st day after laparoscopic hernioplasty according to the ultrasound results, the dynamics of seroma volume, the degree of pain syndrome according to the visual analog scale (VAS), the duration of surgical intervention, 30-day adverse events, as well as the patients’ quality of life according to the Likert scale.
RESULTS. A total of 142 patients were included (n1=71; n2=71). There were no significant differences in baseline characteristics between the two groups. Suturing the hernia defect using the integral suture technique was associated with less development of postoperative seromas ∆p=0.32 (95 % confidence interval [CI] 0.14–0.5, p=0.05). There were no statistical differences in pain and quality of life among patients. No 30-day adverse events were observed in the two groups. A statistically significant increase in the duration of the operation when using the integral suture was revealed, but not more than 7 minutes.
CONCLUSION. Since anatomical justification has made laparoscopic hernioplasty a safer operation, we believe that endoscopic suturing of rectal inguinal hernia defect larger than 2.5 cm (P=0.052) with the use of integral suture in the MP2 group according to EHS is associated with a lower incidence of seroma development, low risk of recurrence, absence of significant pain syndrome after suturing.

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