Reply to Comment to: Preperitoneal closed-system suction drainage after totally extraperitoneal hernioplasty in the prevention of early seroma formation: a prospective double-blind randomized controlled trial

Excerpt

Thank you for your letter concerning our recent publication on preperitoneal drainage after TEP. As mentioned in the manuscript, we do agree that seroma formation itself is not a complication of hernia surgery; rather it is an unavoidable sequelae. Although the occurrence of a seroma causes no harm to patients, it creates psychological burden and maybe a risk factor for post-operative pain (we observed there was a trend to have less pain in the drain group versus the non-drain group in the first week post-operation). It is for this reason that we are trying to explore the feasibility and clinical safety of a traditional surgical approach to solve this clinical problem. Numerous techniques have been proposed to reduce the incidence of seroma formation but none was proven to be clinically effective, except closure of a pseudosac with braided sutures as described by Li et al. However, the authors included only patients with direct inguinal hernias, both primary and recurrent. This study was a non-randomized, non-consecutive, involved only a small sample size (25 patients with 36 hernias), not blinded, and was heterogeneous in operative technique (TAPP versus TEP, different meshes used for different patients), etc. Therefore, this technique which might sound promising at this stage requires a large-scale RCT to prove its clinical efficacy as proposed by author. …