COMPARATIVE STUDY OF FIXATION VERSUS NON FIXATION OF PSEUDOSAC IN LAPAROSCOPIC INGUINAL HERNIA SURGERY

Abstract

Background: The sac encountered in a direct inguinal hernia is typically not a true peritoneal sac but a bulge of thinned-out transversalis fascia, commonly termed the "pseudosac." Opinion remains split on whether this structure should be actively fixed during laparoscopic repair or simply reduced and left alone, and few studies have directly weighed one approach against the other. Objective: To compare pseudosac fixation with non-fixation during laparoscopic repair of direct inguinal hernias, with particular attention to seroma rates, recurrence, time taken in theatre, and postoperative pain. Methods: Sixty patients who had undergone laparoscopic direct inguinal hernia repair at Saveetha Hospital, Department of General Surgery, between January 2023 and December 2025 were reviewed retrospectively and split evenly into a fixation arm and a non-fixation arm (30 each). Case records were used to capture patient demographics, intraoperative findings, time taken for the procedure, postoperative complications (seroma and haematoma), and duration of hospital admission. Group differences in categorical variables were tested using the chi-square test, taking p < 0.05 as the threshold for significance. Results: By 48 hours, more patients in the fixation arm reported pain above VAS 3 than in the non-fixation arm (33.3% vs 10.0%; p = 0.03). Seroma, on the other hand, occurred only in the non-fixation arm (16.7% vs 0.0%; p = 0.02). Rates of urinary retention and haematoma were similar between groups, and neither arm recorded a recurrence. Conclusion: Fixing the pseudosac appears to trade a modest amount of extra pain and operating time for protection against seroma, whereas leaving it unfixed shortens the procedure at the cost of a higher seroma rate. With recurrence equally absent in both arms, the decision between the two techniques is best left to individual patient factors and operator preference rather than a blanket recommendation.