Vol.:(0123456789) 1 3 Hernia https://doi.org/10.1007/s10029-022-02724-5 REVIEW Does closure of the direct hernia defect in laparoscopic inguinal herniotomy reduce the risk of recurrence and seroma formation?: a systematic review and meta‑analysis M. Petersen 1  · H. Friis‑Andersen 1  · N. Zinther 1 Received: 22 September 2022 / Accepted: 20 November 2022 © The Author(s), under exclusive licence to Springer-Verlag France SAS, part of Springer Nature 2022 Abstract Purpose Recurrence is a known complication to inguinal herniotomy with an incidence of 10 to 15 percent (Hernia Surge Group in Hernia 22:165, 2018). Previous studies have shown that direct hernia or large defects are risk factors for postop- erative seroma formation (Morito et al. in Surg Endosc https://doi.org/10.1007/s00464-021-08814-2, 2021). These types of defects are often closed during open herniotomy (Rosenberg et al. in Dan Med Bull 58: C4243, 2011). This is not routine during laparoscopic surgery. A recent study has indicated that closure of the medial defect during laparoscopy may reduce recurrence and seroma formation. As a result, we performed the present systematic review to evaluate the efcacy of this add on to the standard procedure. Methods An extensive search was carried out in PubMed and Embase. All studies involving adults undergoing laparoscopic direct hernioplasty were enrolled and screened with predefned inclusion criteria, to be part of a systematic review with data synthesis and meta-analysis. Results The search identifed 108 publications of which four met the inclusion criteria. Two studies (Ng et al. in Hernia 24:1093–1098, 2020; Usmani et al. in Hernia 24:167–171, 2020) showed reduced risk of recurrence. The remaining studies (Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18–21, 2019; Li and Zhang in Surg Endosc 32:1082–1086, 2018) reported no recurrence in any of the patients included. Two articles (Usmani et al. in Hernia 24:167–171, 2020; Zhu et al. in Surg Laparosc Endosc Percutan Tech 29:18–21, 2019) showed a decrease in risk of postoperative seroma, one showed a signifcant increase (Ng et al. in Hernia 24:1093–1098, 2020). None of the included studies showed an increase in the risk of postoperative pain or postoperative complications. Conclusion This review suggests that closure versus non-closure of the medial hernia defect in laparoscopic inguinal hernio- plasty reduces the risk of recurrence and seroma formation without an increase in postoperative pain or complications. Further randomized controlled trials are needed for further evaluation. Keywords Hernioplasty · Laparoscopy · Recurrence · Seroma · Inguinal hernia Introduction The lifetime risk of Inguinal hernia in men is 27% [8] and more than 20 million patients undergo groin hernia repair annually worldwide [1] Laparoscopic hernia repair can be performed either by a Transabdominal PrePeritoneal approach (TAPP) or Total ExtraPeritoneal (TEP) approach [2]. In terms of recurrence, postoperative pain and complications, both techniques show similar results [9]. The risk of recurrence has improved dra- matically during the last century with technical advance- ments, such as the introduction of open mesh repair and laparoscopic surgery, with a risk of recurrence after her- nia repair under 2% [10]. However, recurrence is still one of the most important postoperative complications, and afects quality of life with potential pain, incarceration and reoperation as a result [3]. There is a signifcantly higher risk of recurrence after medial vs lateral hernia repair [11]. Chronic postoperative pain is another serious complication * M. Petersen madspese@rm.dk 1 Department of Surgery, Horsens Regional Hospital, Sundvej 30, 8700 Horsens, Denmark