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Purpose <p>To evaluate the Cruciate Gear Suture (CGS) technique for pseudo-sac management in transabdominal preperitoneal prosthesis (TAPP) repair of direct inguinal hernias.</p> Methods <p>A prospective randomized controlled single-center trial was undertaken on adult patients with primary direct inguinal hernia from April to August 2025. A computer-generated random number table assigned patients to the CGS (experimental) and single-hand four-needle suture (control) groups. The primary and secondary outcomes encompassed management time for the pseudo-sac, total operation duration, length of hospital stay, medical expenses, postoperative 24-h Visual Analog Scale (VAS) score, one-week postoperative Carolina Comfort Scale (CCS) score, incidence of seroma, and recurrence rate. SPSS 31.0 was used for data analysis.</p> Results <p>The trial included 53 patients (71 pseudo-sacs), 26 in the experimental group and 27 in the control group. Baseline factors (age, BMI, comorbidities, hernia defect size) were not significantly different across groups (<i>P</i> &gt; 0.05). CGS had a substantially shorter pseudo hernia sac suturing time than the control group [188 (165, 213.5) s vs 220 (195, 281) s, <i>Z</i> = −2.929, <i>P</i> = 0.003]. Subgroup analyses showed further benefits for 2–3&#xa0;cm (<i>Z</i> = −2.700, <i>P</i> = 0.006) and 3–4&#xa0;cm (<i>Z</i> = −2.088, <i>P</i> = 0.036) defects. Total operation time, 24-h VAS score, hospital stay, medical expenses and one-week postoperative CCS score did not differ (<i>P</i> &gt; 0.05). With an average follow-up period of 4.85&#xa0;months, no significant differences were observed in the duration of postoperative groin irritation (<i>P</i> &gt; 0.05), and the incidence of seroma and recurrence rates were 0% in both groups.</p> Conclusion <p>The CGS technique significantly reduces pseudo-sac suturing time while maintaining comparable safety, efficacy, and cost-effectiveness to the conventional single-hand four-needle group.</p>

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Cruciate gear suture: a simple and effective technique for pseudo-sac management in TAPP

  • 期刊论文

  • 发表日期：

    2026年3月11日

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  • Jinghao Mei,
  • Jinlin Liu,
  • Kai Lin,
  • Fan Luo,
  • Xuyuan Chen,
  • Chun Yang

摘要

Purpose

To evaluate the Cruciate Gear Suture (CGS) technique for pseudo-sac management in transabdominal preperitoneal prosthesis (TAPP) repair of direct inguinal hernias.

Methods

A prospective randomized controlled single-center trial was undertaken on adult patients with primary direct inguinal hernia from April to August 2025. A computer-generated random number table assigned patients to the CGS (experimental) and single-hand four-needle suture (control) groups. The primary and secondary outcomes encompassed management time for the pseudo-sac, total operation duration, length of hospital stay, medical expenses, postoperative 24-h Visual Analog Scale (VAS) score, one-week postoperative Carolina Comfort Scale (CCS) score, incidence of seroma, and recurrence rate. SPSS 31.0 was used for data analysis.

Results

The trial included 53 patients (71 pseudo-sacs), 26 in the experimental group and 27 in the control group. Baseline factors (age, BMI, comorbidities, hernia defect size) were not significantly different across groups (P > 0.05). CGS had a substantially shorter pseudo hernia sac suturing time than the control group [188 (165, 213.5) s vs 220 (195, 281) s, Z = −2.929, P = 0.003]. Subgroup analyses showed further benefits for 2–3 cm (Z = −2.700, P = 0.006) and 3–4 cm (Z = −2.088, P = 0.036) defects. Total operation time, 24-h VAS score, hospital stay, medical expenses and one-week postoperative CCS score did not differ (P > 0.05). With an average follow-up period of 4.85 months, no significant differences were observed in the duration of postoperative groin irritation (P > 0.05), and the incidence of seroma and recurrence rates were 0% in both groups.

Conclusion

The CGS technique significantly reduces pseudo-sac suturing time while maintaining comparable safety, efficacy, and cost-effectiveness to the conventional single-hand four-needle group.