Seroma in Laparoscopic Ventral Hernioplasty

Abstract

Seroma is a frequent complication of laparoscopic or open repair of ventral hernias using expanded polytetrafluoroethylene mesh. Aspiration of this seroma has the risk of introducing bacteria, resulting in infection and the recurrence of the hernia. Between May 1996 and December 2000, 51 patents who underwent 53 laparoscopic ventral hernioplasties (44 incisional, 5 large epigastric, and 4 large umbilical) were randomized to participate in a trial comparing the intraperitoneal onlay mesh repair with or without cauterization of the hernia sac. Group A (26 patients; 28 hernias) patients were operated on by using an expanded polytetrafluoroethylene Dual Mesh patch (Gore and Associates, Flagstaff, AZ, U.S.A.) inserted intraperitoneally and secured by full-thickness stitches and endoscopic clips to cover the hernia defect, while the sac was left intact. Group B (25 patients, 25 hernias) patients were operated on according to the same technique as those in group A, but the hernia sac was cauterized by monopolar cautery (5 cases) or harmonic scalpel (20 cases). After surgery, clinical examination and computed tomography scans were used to confirm or test the existence of seroma and recurrence. In group A, four clinically evident seromas were found. Two of them were resolved with no intervention. In the remaining two cases, multiple aspirations were needed for 4 and 7 months, respectively, but 2 and 3 months, respectively, after resolution of the seroma, a recurrence of the hernia was observed. There was one more recurrence without seroma and three with subclinical seromas (only observed on computed tomography scans). In group B, subclinical seroma (only observed in computed tomography scan) resolved in a few days, and one recurrence without seroma was observed. Although only a small number of patients were studied, our findings suggest that the cauterization of the hernia sac prevents seromas and reduces recurrences in laparoscopic repair of ventral hernias.

Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair

“…(8-35 %) [1,6,7,[12][13][14][15][16][17][18]. The latter data confirms other aspect widely reported in literature, namely, that ultrasound comparated to clinical examination is a better tool to diagnose the presence of PS.…”

“…The results of our experience do not differ from those reported in the literature [1,6,7,[12][13][14][15][16][17][18], both as regards the clinical incidence of PS after LVHR (8.6 % of operated patients) and its sonographic diagnosis (93.5 % of operated patients).…”

“…Because the definition and evaluation criteria used in several published studies (clinical or and/or radiological) are not always the same [1,2,6,7,[12][13][14][15][16][17][18]. ; for this reason it would be useful to have a tool that allows a classification shareable for PS.…”

“…The postoperative seroma (PS) is considered the most common complication after LVHR; consists of a fluid collection, predominantly serous, that develops in the periprosthetic space, caused by physiological inflammatory response of tissues to the prosthetic material and which is favored by the non excision of the peritoneum of the hernia sac (which represents a dead space between the mesh and abdominal wall) [12][13][14][15][16][17][18]; the peak of PS formation occurs around the 7th day after the intervention and its reabsorption is nearly complete within 90 days [12].…”

Laparoscopic plasty of ventral hernias in patients with concomitant abdominal organs diseases

“…В то же время серьезными осложнениями лапароскопических аллопластик яв-ляются невралгии, внутрибрюшные кровотечения, незамеченные повреждения кишечника с развитием перитонита и сепсиса [8].…”