Sac transection versus sac reduction during laparoscopic herniorrhaphy: A systematic review and meta-analysis

Shion Wei Chai, Po Hsing Chiang, Chin Ying Chien, Yi Chan Chen, Ruey Shyang Soong, Ting Shuo Huang

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)


Hernia repair techniques have evolved recently; however sac handling remains a critical step. Transection of the herniated sac as opposed to total sac reduction may simplify the procedure. However, residual sac tissue may increase the risk for seroma formation. We performed a systemic review and meta-analysis to evaluate the safety and feasibility of transecting the hernia sac during laparoscopic herniorrhaphy. Relevant literature search was performed in PubMed, EMBASE, SCORPUS, and the Cochrane Library databases. Relevant studies that compared total reduction with transection of the herniated sac during laparoscopic herniorrhaphy were included. The primary outcome measure was the incidence of seromas. We also analyzed secondary outcomes including operative duration, postoperative pain scores, complications, and hernia recurrence rate. Of the 330 studies identified, four studies published between 2002 and 2020, with sample sizes ranging from 70 to 520 patients, met the inclusion criteria. Overall, 848 hernias were evaluated. We observed a high incidence of seroma formation in the sac transection group compared to that in the sac reduction group (OR 2.41; 95% CI 1.39 to 4.17, P = 0.002), but the groups did not differ significantly with respect to factor such as operative duration, postoperative complications, and pain score. Herniated sac transection during laparoscopic herniorrhaphy might be associated with a higher risk of seroma formation than that observed with sac reduction. The former approach did not show any significant benefits compared to the latter approach with respect to operative duration and postoperative complications.

Original languageEnglish
Pages (from-to)981-986
Number of pages6
JournalAsian Journal of Surgery
Issue number4
Publication statusPublished - Apr 2022
Externally publishedYes


  • Laparoscopic herniorrhaphy
  • Sac reduction
  • Sac transection
  • Seroma

ASJC Scopus subject areas

  • Surgery


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