Analysis Of Risk Factors Of Seroma After Transabdominal Preperitoneal Inguinal Hernia Repair And Construction Of Prediction Model

ObjectiveTo study the risk factors of seroma after transabdominal preperitoneal inguinal hernia repair and establish a prediction model,providing clinical reference for the treatment of inguinal hernia and the prevention and treatment of postoperative complications.Materials and methodsThis retrospective study analyzed the clinical data of 192 patients who received tension-free laparoscopic transabdominal preperitoneal unilateral inguinal hernia repair at the Department of Thyroid,Metabolic Disease and Hernia Surgery of the First Affiliated Hospital of Dalian Medical University from January 1,2022 to July 31,2022.After screening,158 patients with inguinal hernia were finally included.According to whether patients had seroma after surgery,patients were divided into groups with seroma(group S)and without seroma(group NS).Clinical characteristics of all patients were recorded,and the relationships between gender,age,BMI(Body Mass Index),hypertension,diabetes,previous preperitoneal space operation history,albumin,total protein,hernia affected side,hernia course,hernia type,hernia sac size,operation duration,mesh material,negative pressure drain and postoperative seroma were analyzed.Univariate analysis was performed for each feature and seroma,and the significant ones were included in multivariate logistic regression analysis to explore the risk factors of seroma after tension-free laparoscopic transabdominal preperitoneal unilateral inguinal hernia repair.Besides,Pearson or Spearman correlation analysis was used to explore the correlation among features.Finally,we attempted to construct a Nomogram model for postoperative seroma,and then drew the ROC curve and calculated the AUC and consistency C index.At the same time,we evaluated the model by using H-L goodness of fit test and internal verification to draw calibration curves.ResultsUnivariate analysis showed that the proportion of obese patients in group S(BMI≥30Kg/m2)was much higher than that in group NS(21.1%vs 5.8%,P=0.040).In the S group,the proportion of hypertension patients was 42.1%,while in the NS group,the proportion of hypertension patients was only 20.1%(P=0.043).The proportion of patients in the S group with a history of preperitoneal space operation was higher than that in the NS group(15.8%vs 2.2%,P=0.024).The median size of hernia sac in group S was higher than that in group NS(5.50cm vs 4.20cm,P=0.034),and the proportion of patients with hernia sac≥5.25cm in group S was larger than that in group NS(57.9%vs 21.6%,P=0.002).The use rate of biological mesh in S group was higher than that in NS group(31.6%vs 11.5%,P=0.029).In this study,the occurrence of postoperative seroma was not significantly correlated with gender,age,diabetes,albumin,total protein,hernia affected side,hernia course,hernia type,operation duration,negative pressure drain(P>0.05).Multivariate logistic analysis showed that combined with previous preperitoneal space surgery history(OR=46.9,P<0.05),obesity BMI≥30Kg/m2(OR=5.9,P=0.044),use of biological mesh(OR=4.5,P=0.033)and hernia sac≥5.25cm(OR=8.9,P=0.001)were independent risk factors for seroma after peritoneal preperitoneal repair of inguinal hernia.The Nomogram model established in this study showed that history of preperitoneal space operation was the most important predictor of seroma,followed by hernia sac size,BMI and mesh material.The area under the curve and the consistency index C index were 0.797,indicating that the model had a good discrimination.The chisquare value of H-L goodness of fit of the model was 3.571,P=0.168,and the internal verification calibration curve showed that the predicted value of the model was close to the measured value,indicating that the model had good accuracy.In addition,Spearman correlation analysis showed that hernia sac size was positively correlated with the disease course(P=0.018).The size of hernia sac was positively correlated with the length of operation(P<0.001).Conclusion1.Patients who were obese(BMI≥30Kg/m2),combined with previous preperitoneal space surgery,hernia sac≥5.25cm,and who used biological mesh for transabdominal preperitoneal hernia repair had a higher risk of postoperative seroma;2.The best cutting point value of the hernia sac before surgery for predicting postoperative seroma after laparoscopic inguinal hernia repair was 5.25cm.3.The longer the disease course,the larger the hernia sac;The larger the hernia sac,the longer the operation duration.It is suggested that early treatment should be carried out for inguinal hernia patients in clinic.