To analyse the effect of laparoscopic defect closure in direct inguinal hernia repairs (Total Extra-Peritoneal and Trans-Abdominal Pre-Peritoneal Plus repairs) on post operative outcomes

Following totally extraperitoneal (TOTAL EXTRA-PERITONEAL REPAIRS) and transabdominal preperitoneal (TRANS ABDOMINAL PRE-PERITONEAL PLUS REPAIRS) repair, complications such as seroma formation, hernia recurrence, and postoperative pain have continued to present challenges to surgeons. Studies have demonstrated lower post-operative pain and shorter time to recovery associated with laparoscopic inguinal hernia repair when compared to open surgery. However, some studies have also described higher rates of seroma formation (up to 12%) and recurrence (up to 5%) with laparoscopic inguinal hernia repair, which      can result in decreased quality of life. In 2019, a study done in Singapore posited a modified laparoscopic technique involving primary closure of the direct hernia defect prior to mesh insertion in patients with direct inguinal hernia. They demonstrated a statistically significant reduction in recurrence and seroma formation, especially in certain at-risk patient populations, and proposed to name this procedure the “TOTAL EXTRA-PERITONEAL AND TRANS ABDOMINAL PRE-PERITONEAL PLUS” technique. Direct defect closure has proven to be effective in reducing recurrence and seroma formation post-operatively in patients undergoing laparoscopic inguinal hernia repair. The study stated that randomized controlled trials are required to further evaluate these outcomes. This is a prospective interventional parallel arm randomised controlled trial to be conducted at Sri Ramachandra Institute of Higher Education and Research. After obtaining consent, the patients will be assigned to case (closure of defect) and control (non-closure of defect) groups, using coin toss method. Closure of defect will be standardised with 2-0 VLOC barbed absorbable monofilament suture, and  psuedosac will be incorporated during defect closure. Incidence of postoperative complications namely post-operative pain, seroma formation and recurrence of hernia will be compared, with serial follow-up at 1 week, 1 month, and 3 months postoperatively.