Objective To investigate the clinical value of conventional instrument single-port laparoscopic transabdominal preperitoneal prosthesis (TAPP) for inguinal hernia and the influen-cing factors of postoperative seroma.
Methods The retrospective cohort study was conducted. The clinical data of 1 427 patients with inguinal hernia who were admitted to Affiliated Hospital of Nantong University from March 2020 to March 2025 were collected. There were 1 260 males and 167 females, aged (63±11) years. All patients underwent conventional instrument single-port laparo-scopic TAPP. Observation indicators: (1) surgical conditions; (2) postoperative conditions; (3) follow-up; (4) analysis of influencing factors for seroma after conventional instrument single-port laparos-copic TAPP.Comparison of measurement data with normal distribution was conducted using the inde-pendent sample t test, comparison of measurement data with skewed distribution was conducted using the Mann-Whitney U test. Comparison of count data was conducted using the chi⁃square test. Univariate analysis was conducted using corresponding statistical methods based on the type of indicators, and multivariate analysis was performed using the Logistic regression model.
Results (1) Surgical conditions: of the 1 427 patients, 1 406 cases completed the surgery successfully, 21 cases were converted to three-port surgery, and no patient was converted to open surgery. The operation time was (22±9) minutes of 1 346 patients with unilateral hernia, and (41±13) minutes of 81 patients with bilateral hernia. The volume of intraoperative blood loss of the 1 427 patients was (6.5±1.8) mL. Of 1 427 patients, 5 cases had vascular injury due to intraoperative trocar insertion, 2 cases had neuronal injury, and no patient had intraoperative adjacent organ injury. (2) Postoperative condi-tions: the first ambulation time of the 1 427 patients was (6.5±2.2) hours, duration of postoperative hospital stay was 1(1,2) days, total hospitalization cost was (16 250±1 480) yuan. Postoperative pain occurred in 91 cases with visual analog scale score as 2(1,3) at 24 h postoperatively, urinary retention in 69 cases, wound infection in 3 cases. There was no mesh infection.(3) Follow-up: all the 1 427 patients were followed up for at least 1 year, with the follow-up time of 38 (24,52) months. During the follow-up, chronic pain occurred in 46 cases, seroma in 283 cases, hernia recurrence in 1 case, and no adhesive intestinal obstruction or trocar site hernia was observed. The aesthetic surgical score of 1 427 patients was 9.97±0.24. (4) Analysis of influencing factors for seroma after conventional instrument single-port TAPP: results of multivariate analysis showed that body mass index (BMI) >28 kg/m², preoperative albumin <30 g/L, hernia recurrence, disease duration >3 years, long-term anticoagulant use, and hernia ring diameter >3 cm were independent risk factors for postoperative seroma (odds ratio=1.63, 2.18, 2.14, 1.64, 1.72, 1.39, 95% confidence interval as 1.09-2.44, 1.07-4.45, 1.21-3.78, 1.22-2.20, 1.15-2.57, 1.02-1.90, P<0.05).
Conclusions Conventional instrument single-port laparoscopic TAPP is safe and feasible for inguinal hernia with good cosmetic outcomes. BMI >28 kg/m², preoperative albumin <30 g/L, hernia recurrence, disease duration >3 years, long-term anticoagulant use, and hernia ring diameter > 3 cm are independent risk factors for postoperative seroma.
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