***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objectives Seroma is a virtually unavoidable early sequela after TEP hernioplasty . This r and omised controlled trial evaluated the outcomes of preperitoneal closed-system suction drainage in  laparoscopic totally extraperitoneal ( TEP ) hernioplasty for inguinal hernia . Methods Ninety patients aged 18–80 years who presented to our hospital between May 2016 and February 2017 with primary unilateral inguinal hernia were r and omised into the preperitoneal drain and no-drain groups . The primary outcome was seroma size on postoperative day 6 . Secondary outcomes included clinical seroma formation and seroma size on day 1 , day 6 , 1 and 7 months postoperatively , length of postoperative stay , pain score , and recurrence . Results There was no significant difference in age , sex , co-morbidities , hernia side , mean hernia size , operating time , fixation adjuncts , or postoperative stay . The overall incidence of clinical seroma formation was 25.6 % on postoperative day 1 , 60.3 % on postoperative day 6 , 13.2 % 1 month and 0 % 7 months postoperatively . The mean drain output was 57.9 ml . The drain group had significantly fewer patients with seroma on day 1 ( 6 vs 14 , p = 0.022 ) and day 6 ( 17 vs 30 , p = 0.000 ) , and a smaller mean seroma size on days 1 and 6 ( p = 0.000 ) . Subgroup analysis showed that sac ligation versus reduction , peritoneal perforation , and fixation adjuncts had no significant effects on seroma formation or size . There is a trend of lower early post-operation VAS score and more urinary retention in drain group was observed but not reaching statistical significance . No differences in postoperative pain score or complications were observed at 1 and 7 months ’ post operation . Conclusions Preperitoneal drainage for 23 h after laparoscopic TEP hernioplasty for inguinal hernia can effectively decrease seroma formation in the early postoperative period , and potentially improving postoperative pain . The benefit is short-term and no significant difference was demonstrated after 1-month post operations . This tradition technique applied to novel operative repair of inguinal hernia is safe and feasible with no significant morbidity demonstrated . Preperitoneal drainage after TEP can be considered as an option to improve patient satisfactions and recovery in selected patient group for maximal benefit , especially for those with prolonged operation which may associate with higher chance of seroma formation BACKGROUND Massive incarcerated scrotal hernias are usually managed by an open method . Some experienced surgeons have successfully attempted laparoscopic management of such cases . Total extraperitoneal repair ( TEP ) is the laparoscopic technique of choice for the repair of groin hernia . Many authors have suggested that transabdominal preperitoneal ( TAPP ) is the preferred approach to these hernias . The purpose of this study is to show our results of TEP repair of giant scrotal hernias . PATIENTS AND METHODS In the present study a total of 21 ( 20 patients ) out of 291 groin hernias ( 185 patients ) were included and evaluated prospect ively . TEP was successful in 14 ( 66.6 % ) with a conversion to TAPP in 4 ( 19.04 % ) and open procedure in 3 ( 14.28 % ) cases , respectively . Postoperative complications included scrotal hematoma in 5 ( 25 % ) , spermatic cord edema in 6 ( 30 % ) , and seroma in 14 ( 70 % ) patients . There was no recurrence of hernia noticed during mean follow-up of 36 months ( range , 22 - 51 ) . CONCLUSION Laparoscopic TEP repair was successful with excellent outcome in the management of massive incarcerated groin hernia in the h and s of an experienced laparoscopic surgeon Purpose Seroma is among the most common complications of laparoscopic total extraperitoneal ( TEP ) for especially large indirect inguinal hernia , and may be regarded as a recurrence by some patients . A potential area localized behind the mesh and extending from the inguinal cord into the scrotum may be one of the major etiological factors of this complication . Our aim is to describe a novel technique in preventing pseudorecurrence by using fibrin sealant to close that potential dead space . Methods Forty male patients who underwent laparoscopic TEP for indirect inguinal hernia with at least 100-mL volume were included in this prospect i ve clinical study . While fibrin sealant was used to close the potential dead space in the study group , nothing was used in the control group . The volume of postoperative fluid collection on ultrasound was compared between the groups . Results Patient characteristics and the volumes of hernia sac were similar between the 2 groups . The mean volume of postoperative fluid collection was found as 120.2 mL in the control group and 53.7 mL in the study group , indicating a statistical significance ( P < 0.001 ) . Conclusion Minimizing the potential dead space with a fibrin sealant can reduce the amount of postoperative fluid collection , namely the incidence of pseudorecurrence Abstract Introduction : Endoscopic repair was introduced for use with inguinal hernia therapy more than 10 years ago . The technique as well as the indications for this method are debated , however . As a borderline inguinal hernia situation , the scrotal hernia in particular evokes vehement objections to an endoscopic procedure because of the anticipated problems and complications in dissecting the extended hernia sac . The efficiency of the laparoscopic transabdominal preperitoneal ( TAPP ) technique in the treatment of scrotal hernia therefore is discussed in this article . methods : Laparoscopic hernia repair ( TAPP ) has been performed in our department since 1993 . Data are collected by a prospect i ve documentation of operative and follow-up results . For evaluation , a comparison of scrotal and normal hernia repair was performed . Results : Between April 1993 and June 1998 the TAPP technique was used to treat 191 scrotal hernias , 42 ( 22 % ) of which were recurrent hernias . The median operating time for a nomal inguinal hernia repair was 45 min , whereas scrotal hernias required a median of 65 min and irreducible scrotral hernias a median of 68.5 min . Major complications were observed in 1.6 % of scrotal and 0.6 % of normal inguinal hernia repairs . The most frequent scrotal hernia repair problem was the formation of a seroma , 10.5 % of which had to be avacuated . During a follow-up period of 30 months , we found a total of two recurrences ( 1.05 % ) . Conclusion : In scrotal hernia repair , TAPP is not associated with higher complication rates and can be performed with efficiency comparable with that in normal inguinal hernia repair Introduction Seroma is a frequent complication of endoscopic totally extraperitoneal ( TEP ) mesh repair of direct inguinal hernia that may cause discomfort and anxiety . Its volume is proportional to the size of the preperitoneal dead space created after the reduction of the hernia . Attempts to reduce its incidence have included tacking the transversalis fascia ( TF ) to the pubic ramus or closed suction drainage of the preperitoneal space . Both of these techniques are not without problems . The aim of this study was to evaluate the efficiency of a new alternate technique that must be safe and easily reproducible , using a widely available and inexpensive pre-tied suture loop ( Endoloop ® Ligature ) for plication of the weakened TF . Methods This is a prospect i ve study of consecutive patients diagnosed with inguinal hernia during a 33-month period and eligible for endoscopic TEP repair . A single surgeon performed all operations . Each of the M2 or M3 direct defects , according to the European Hernia Society ( EHS ) , were systematic ally closed prior to the introduction of the prosthetic mesh and as follows : grasping and inversion of the attenuated TF at its apex , using a laparoscopic forceps and plication of the TF by placing a tight Endoloop of Polydioxanone ( PDS ) at its base . All meshes were secured with fibrin sealant only . Patients were review ed in the clinic 2 and 6 weeks after the operation . Further follow-up was scheduled if it was deemed necessary . The primary post-operative outcome parameter was seroma formation ; secondary outcome parameters included groin pain , surgical complications , and recurrence . Results Two hundred and fifty hernia repairs were prospect ively recorded during this period . All procedures were carried out endoscopically . Seventy-nine patients with 94 direct inguinal hernias were selected in a sequential manner . There were 75 males and four females , with a median age of 57 years . Of those , 55 were combined with an indirect inguinal defect . In total , Endoloops of PDS were used to close the weakened TF in 76 cases ( 30 M3 , 44 M2 , and two M1 ) . Only one patient ( 1.3 % ) complained of a residual seroma formation , which was still clinical ly present at 3 months post-operatively , but was not symptomatic . There were only two minor post-operative complications , which occurred in the same patient and were not related to the Endoloop technique . Finally , no patient complained of chronic groin pain and there was no hernia recurrence after a median follow-up of 18 months . Conclusions The primary closure of direct inguinal hernia defects with a pre-tied suture loop during endoscopic TEP repair is safe , efficient , and very reliable for the prevention of post-operative seroma formation , without increasing the risk of developing chronic groin pain or hernia recurrence . This technique should be the preferred method over stapling of the TF or the insertion of a closed suction drainage device in such a situation Background : Because it mimics a postoperative recurrence of hernia , seroma has been a concern to patients . There has been no consensus on the management of this condition after  endoscopic totally extraperitoneal inguinal hernioplasty ( TEP ) .  The objectives of the present study were to evaluate the incidence and treatment of seroma after TEP . Risk factors for the development of seroma were also examined . Methods : A total of 450 consecutive patients who underwent TEP between June 1999 and May 2002 were recruited . All data were collected prospect ively . The outcomes of patients who developed seromas were compared to those without this postoperative complication . Regression analysis was performed to identify independent risk factors for seroma formation . Results : The overall incidence of seroma formation was 7.2 % ( n = 40 ) . The postoperative recovery of patients was not influenced by the development of seroma . The mean size of the seromas was 3.8 cm . Adopted treatment strategies included observation ( n = 29 ) , oral lysozyme ( n = 10 ) , and percutaneous aspiration ( n = 3 ) , but neither of the two interventions appeared to be effective . The seromas resolved spontaneously by an average of 2.4 ( mean ) months . Significant clinical factors associated with seroma formation included old age , large hernial defects , an extension of the hernia into the scrotum , and the presence of a residual distal indirect sac . By logistic regression , a large hernial defect and an extension of the hernia into the scrotum were found to be independent risk factors for seroma formation . Conclusions : Although seroma is a frequent minor morbidity after TEP , it has no impact on postoperative recovery . Because all seromas invariably resolve , expectant treatment with observation is recommended . Inguinoscrotal hernia carries a four-fold increased risk of developing seroma after TEP Purpose Seroma is a frequent postoperative complication after laparoscopic direct inguinal hernia repair  ( both in TAPP and TEP ) . There are several methods to address this problem ; however , these techniques are not without problems . The purpose of this study was to introduce and evaluate a new technique to address this problem . Methods This is a prospect i ve study of consecutive patients . All patients diagnosed with direct inguinal hernias eligible for laparoscopic repair were included . A single surgeon performed all the included operations . During laparoscopic inguinal hernia repair ( TAPP or TEP ) , we closed the direct hernia defect with barbed sutures around the transversalis fascia , inverted the apex of the attenuated transversalis fascia , and sutured it at the base to completely eradicate the defect cavity . Prosthetic mesh was not additionally fixed in all patients . The primary postoperative outcome parameter was seroma formation , and secondary outcome parameters included groin pain , surgical complications , and hernia recurrence . Results Twenty-five male patients with 36 sides of direct hernias were included in this study , and all procedures were carried out laparoscopically and successfully . Only one patient developed significant seroma , which resolved 1 month later . The early postoperative pain was minimal , and no recurrence and chronic pain occurred during the follow-up period ( 4–13 months ) . Conclusions The present direct inguinal hernia defect closing technique with barbed suture is a simple , easily reproducible , and effective method for the prevention of seroma formation Abstract Background The seroma generated between the abdominal viscera and the prosthesis ( retroprosthetic seroma ) , after laparoscopic ventral hernia repair ( LVHR ) with the implant of an intraperitoneal mesh is an unknown entity with few references in the literature . Our objective is to analyze its incidence , clinical repercussions and course of retroprosthetic seroma during the first 3 months post-operation and the factors related to its appearance , such as the relationship to preprosthetic seroma , the size of the prosthesis and 
    Output:
    
ConclusionS eroma formation is a natural process that can not be completely prevented following laparoscopic  inguinal hernioplasty  , especially in patients with direct and large indirect inguinal hernias .
Some intraoperative adjunctive techniques are effective in reducing clinical ly palpable seroma formation in select patients .