Application of Internal Ring Opening Closure Technique in Laparoscopic Totally Extraperitoneal Herniorrhaphy for Type III Indirect Hernia: A Single-Center, Open-Label, Randomized Controlled Clinical Trial.

Abstract

To evaluate the efficacy of the internal ring opening closure technique in laparoscopic totally extraperitoneal herniorrhaphy (TEP) for Type III indirect hernia. From January 1, 2023, to June 30, 2024, 86 patients with Type III indirect or scrotal hernia were randomly assigned to an experimental group or a control group. The primary outcomes included the incidence and volume of seroma at 7 days, 1 month, 3 months, and 6 months postoperatively. Secondary outcomes assessed operative time, hospitalization costs, length of stay, pain scores, postoperative complications, and recurrence rates. TEP was successfully performed in all 86 patients. Baseline characteristics were comparable between the groups. At 7 days and 1 month postoperatively, the experimental group exhibited a significantly lower incidence of seroma (both P < 0.001) and reduced ultrasonic seroma volume (P < 0.001 and P = 0.001, respectively) compared to the control group. However, no significant differences were observed in seroma incidence or volume at 3 and 6 months. The experimental group had a longer operative time (P < 0.001) and slightly higher hospitalization costs (P < 0.001), but pain scores and length of hospital stay did not differ significantly between groups. No chronic pain, recurrence, or other postoperative complications were observed in either group during follow-up. The internal ring opening closure technique in TEP is a safe and effective approach for Type III indirect and scrotal hernias. It significantly reduces postoperative seroma formation without increasing other complications, warranting further clinical investigation.