Primary abandon-of-the-sac technique in laparoscopic inguinoscrotal hernia repair: A retrospective comparative study

Abstract BACKGROUND: Laparoscopic inguinoscrotal hernia repair is a challenging procedure. The surgeon must perform large dissections to reduce the hernial sac, although he has the alternative technique of leaving the sac at the deep inguinal orifice level from the beginning. OBJECTIVE: We aimed to determine the postoperative morbidity of laparoscopic inguinoscrotal hernia repair with the primary abandon-of-the-sac (PAS) technique and to compare it with complete dissection and reduction (CD). Operative times were compared as a secondary outcome. METHODS: A retrospective analysis was conducted between January 2021 and May 2022. The minimum follow-up was 3 months. Postoperative morbidity and operative times in the PAS group were analyzed and compared with those in the CD group. RESULTS: Seventy-eight patients were evaluated. The mean follow-up was 5 months (range, 3–18 months). PAS was performed in 15 patients, while the remaining 63 patients underwent CD. There were no significant differences in demographic and hernia characteristics. An overall morbidity of 30.7% was recorded. No statistical differences were observed in postoperative morbidity between the PAS group and the CD group (33.3% vs. 30.1%; P = 0.81). No statistical differences were found in terms of seromas (13.3% vs. 9.5%; P = 0.662), hematomas (6.6% vs. 9.5%; P = 0.727), or hydrocele (13.3% vs. 11.1%; P = 0.808). No recurrence or chronic pain was observed during the study period. Finally, a significantly shorter median operative time was recorded in the PAS group (50 vs. 80 min; P = 0.0026). CONCLUSION: The PAS technique is safe and feasible for the management of inguinoscrotal hernias. In our series, comparable morbidity rates were found when comparing it with CD. The benefit of the PAS technique is a significant reduction in operative time, despite the fact that it requires more postoperative ultrasounds.