Main Article Content
Introduction: There isn't a widely used definition for seroma but “serous fluid collection in a body space, tissue or organ occurring after surgery or trauma”, is defined as seroma. Symptomatic seromas are common in laparoscopic and open ventral hernia repairs, presented in 8 to 12.5% of patients after open repair by clinical examination at the 8 weeks post-operative control. Several operative measures were done to reduce the development of postoperative seromas after hernia repair as an intra-operative technical step (e.g. quilting sutures) or adjunct procedure (e.g. drain application). During ventral hernias repair, surgeons regularly insert a surgical drain to allow the fluid drainage. Closed drains can be either active (suction) drains or passive (non-suction) drains.
Methods: During the period from August 2018 to October 2019, a total of 100 adult patients presented with different types of ventral hernias, underwent open onlay mesh hernioplasty in the gastrointestinal surgery unit, general surgery department, Tanta University. Patients included in this study were randomly allocated into one of the following two groups using the closed envelope method. Group A included 50 patients with suction tube drain and group B included 50 patients with non-suction tube drain.
Results: There were no statistically significant differences between both groups regarding the patients’ demographics. It was evident that with the use of suction drains from 9th POD the mean daily fluid effluent and the mean total amount of fluid effluent during all follow-up days was significantly lower than in non-suction tube drains. Also, the mean time of drain removal was statistically significantly shorter in group A than in group B.
It was found that cases of ultrasonographic and clinically diagnosed seroma, had compensated chronic liver disease, obesity (BMI > 30 kg\m2), multiple previous abdominal incisions, long period of hernia presence (> 4 years), long-standing partial irreducibility, and large dead space after subcutaneous flap dissection.
Conclusion: Suction drains were removed at a significantly shorter time than non-suction ones under the same rules of management. It also gives significantly lower volume fluid effluent from the 6th POD onwards. Seroma were harder to manage with non-suction tube drains: longer drainage period, worse resolution rates.
Bendavid R, Kux M. Seromas. In: R. Bendavid et al. (eds.), editor. Abdominal Wall Hernias. © Springer Science+Business Media New York. 2001;753–6.
Kingsnorth A , LeBlanc K. Inguinal and incisional hernias. Lancet. 2003;362:1561–71.
Morales-Conde S. A new classification for seroma after laparoscopic ventral hernia repair. Hernia. 2012;16(3):261–7.
Moshe D. Preventing Postoperative Seroma formation in Abdominal wall Hernia by Intraoperative Hypertonic Saline Irrigation, early Report. Open Access J Surg. 2019;10(2).
Bercial ME, Neto MS, Calil JA, et al. Suction Drains, Quilting Sutures, and Fibrin Sealant in the Prevention of Seroma Formation in Abdominoplasty: Which is the Best Strategy? Aesthetic Plast Surg. 2012;36(2):370-3.
Massey LH, Pathak S, Bhargava A, et al. The use of adjuncts to reduce seroma in open incisional hernia repair : A systematic review. Hernia. 2018;22(2):273–83.
Gary DB. Seroma After Surgery: Causes, Symptoms, Treatment, and Prevention, 2018.
Marsh DJ, Fox A, Grobbelaar AO, et al. Abdominoplasty and seroma: A prospective randomised study comparing scalpel and handheld electrocautery dissection. J Plast Reconstr Aesthetic Surg. 2015;68(2):192–6.
Manzoor B, Heywood N, Sharma A. Review of Subcutaneous Wound Drainage in Reducing Surgical Site Infections after Laparotomy. Surg Res Pract. 2015;2015(6):1–6.
Alicuben ET, DeMeester SR. Onlay ventral hernia repairs using porcine non-cross-linked dermal biologic mesh. Hernia. 2014;18(5):705–12.
Andersen LPH, Klein M, Gögenur I, et al. Long-term recurrence and complication rates after incisional hernia repair with the open onlay technique. BMC Surg. 2009;9(1):1–5.
Kingsnorth AN, Shahid MK, Valliattu AJ, et al. Open onlay mesh repair for major abdominal wall hernias with selective use of components separation and fibrin sealant. World J Surg. 2008;32(1):26–30.
Alhussini MA, Awad AT, Kholosy HM. Using quilting sutures in decreasing seroma formation after managing large ventral hernias: A comparative study. Hernia. 2019;23(4):717–22.
Eltantawy M, Elshobaky A, Thabet W, et al. Hernio-abdominoplasty with or without Scarpa’s Fascia Preservation for Ventral Hernia and Abdominal Wall Deformity. Plast Reconstr Surg - Glob Open. 2019;7(7):1–9.
Janis JE, Khansa L, Khansa I. Strategies for postoperative seroma prevention: A systematic review. Plast Reconstr Surg. 2016;138(1):240–52.
Hamila F, Jarrar G, Mohamed B. The duration of drainage after ventral and incisional hernia mesh repairs . A prospective randomized double blind trial Introduction. 2020;1–6.
Schmidt J, Hasselbach A, Schnorr W, et al. Die wertigkeit von wunddrainagen mit und ohne sog: Eine prospektiv randomisierte studie. Unfallchirurg. 2005;108(11):979–86.
Westphalen AP, Araújo ACF, Zacharias P, et al. Repair of large incisional hernias. to drain or not to drain. randomized clinical trial. Acta Cir Bras. 2015;30(12):844–51.
Klink CD, Binnebösel M, Lucas AH, et al. Do drainage liquid characteristics serve as predictors for seroma formation after incisional hernia repair? Hernia. 2010; 14(2):175–9.
Kaafarani HMA, Hur K, Hirter A, et al. Seroma in ventral incisional herniorrhaphy: incidence, predictors and outcome. Am J Surg. 2009;198(5):639–44.