# Plication of fascia transversalis in comparison to no plication to reduce seroma formation post laparoscopic transabdominal preperitoneal repair for direct inguinal hernia : a randomized controlled trial

## TL;DR

This study found that plicating the transversalis fascia during hernia surgery reduces seroma formation and improves recovery.

## Contribution

The study introduces plication of the transversalis fascia as a novel technique to reduce seroma after laparoscopic hernia repair.

## Key findings

- Plication of the transversalis fascia reduced seroma formation in 12.3% of the control group versus 0% in the plication group.
- The plication group showed faster return to normal activity and better pain scores.
- The trial was registered with the Pan African Clinical Trials Registry (PACTR202511671623081).

## Abstract

Seroma is a frequent complication after laparoscopic hernias repair. Many techniques have been proposed to mitigate this issue, yet no approach has been standardized. This study aimed to evaluate the effectiveness of transversalis fascia plication to reduce this.

This randomized controlled trial was conducted at University Hospital from Jule 2024 to October 2025 after approval by the research ethics committee (MS-142-2024), involving adult patients who underwent TAPP repair for direct inguinal hernia. Exclusion criteria were indirect/pantaloon or recurrent hernias, conversion to open surgery, and concurrent procedures. Patients were randomized into two groups by ratio1:1 using computer-generated random sequence with opaque sealed envelopes opened only intraoperative after confirmation of direct hernia: Group A: underwent plication of the fascia transversalis, while the other did not. The primary outcome was the incidence of postoperative seroma. Secondary outcomes included postoperative recovery parameters and the complications. Secondary outcomes included postoperative recovery parameters and the complications.Statistical analysis was performed using SPSS version 27.

146 patients met the inclusion criteria. Demographic characteristics, preoperative comorbidities and hernia size were similar across both groups. At day 30 follow-up, 9 patients (12.3%) in the control group developed clinically detectable seromas, whereas none were in the plication group (p =0.002). Additionally, the plication group demonstrated a significantly faster return to normal activity and better pain scores.

Plication of the transversalis fascia during TAPP may reduce the incidence of seroma formation, and improve postoperative outcomes. Before starting the study, the trial was registered and approved by institutional research ethics committee (MS-142-2024).online, retrospectively registered on the Pan African Clinical Trials Registry (PACTR202511671623081).