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Teng S, Xu M, Yin P, Li H, Wang J, Liu Z. Subcutaneous fat thickness predicts postoperative seroma following laparoscopic total extra-peritoneal hernioplasty. Hernia 2024; 28:1441-1449. [PMID: 38837071 DOI: 10.1007/s10029-024-03078-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 05/20/2024] [Indexed: 06/06/2024]
Abstract
PURPOSE Seroma formation is the most common cause of morbidity associated with laparoscopic inguinal hernia repair. This study aimed to examine the relationship between the thickness of subcutaneous fat (TSF) and the risk of postoperative seroma. METHODS We reviewed data from a prospective cohort of 229 male patients who underwent laparoscopic total extra-peritoneal (TEP) hernioplasty for indirect inguinal hernia between August 2018 and July 2021. The TSF was assessed using preoperative ultrasound images. The risk factors for postoperative seroma were determined using univariate and multivariate logistic regression models. RESULTS Postoperative seromas occurred in 26 patients (11.4%). The factors associated with postoperative seroma included longer hernia duration, larger hernia defects, extension into the scrotum, and greater TSF (P < 0.05). In multivariate analysis, a greater TSF was independently associated with a greater risk of postoperative seroma (per 1 mm: odd ratio [OR] 1.105, 95% confidence interval [CI] 1.048-1.165, P < 0.001; TSF ≥ 26.0 mm: OR 7.033, 95% CI 2.485-19.901, P < 0.001). Similar results were obtained in the subgroup analysis. The area under the curve of TSF for predicting seroma formation was 0.703 (95% CI 0.601-0.806). CONCLUSION Ultrasound-derived TSF may be a promising prognostic factor for postoperative seroma in patients undergoing laparoscopic TEP repair. Further validation is required and then this parameter can be used to improve decision-making process.
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Affiliation(s)
- Shigang Teng
- Department of Gastrointestinal surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong Province, China
| | - Mingyue Xu
- Department of TCM, Suqian First Hospital, Suqian, Jiangsu Province, China
| | - Peng Yin
- Department of Gastrointestinal surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong Province, China
| | - Haifeng Li
- Department of Gastrointestinal surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong Province, China
| | - Junping Wang
- Department of Radiology, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong Province, China
| | - Zhongcheng Liu
- Department of Gastrointestinal surgery, Jiaozhou Central Hospital of Qingdao, Qingdao, Shandong Province, China.
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Yildiz A, Yucel M. Endo-laparoscopic scrotal hernia surgery: which technique must we choose to reduce seroma-sac transection or complete sac reduction? A prospective study. Updates Surg 2024; 76:607-612. [PMID: 37831327 DOI: 10.1007/s13304-023-01666-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 09/29/2023] [Indexed: 10/14/2023]
Abstract
Seroma formation is one of the important postoperative problems in inguinal hernia surgery, especially after scrotal hernia surgery. The present study aimed to present primarily the incidence of seroma after reduction and transection of the hernia sac in endo-laparoscopic scrotal hernia repair, and secondarily the results of early postoperative complications. Patients were divided into two groups TAPP and TEP. These groups were also divided into transection and reduction subgroups. In the reduction group, the hernia sac was completely dissected and pulled to the peritoneal area, while in the transection group, the neck of the hernia sac was cut by ligating, and its distal part was fixed to the posterior abdominal wall. The groups were compared, and data were analyzed. The reduction was performed in 13 (43.33%) of the 30 patients included in the study, and transection in 17 (56.67%). Seroma developed in 2 (15.38%) of the reduction group and 7 (41.18%) of the transection group. There was no statistical difference between the groups (p = 0.229). Cord and testicular complications were seen in 6 (20%) patients, 5 (38.46%) in the reduction group, and 1 (5.88%) in the transection group. No statistical difference was detected between the groups (p = 0.061). Although not statistically significant, seroma was more common in transection, while cord and testicular complications were more common in reduction. If dissection of the hernia sac is difficult, the complete reduction should not be insisted on, and the neck of the sac should be transection by ligating, and its distal part should be fixed to the posterior abdominal wall.
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Affiliation(s)
- Abdullah Yildiz
- Department of General Surgery, Umraniye Training and Research Hospital, Adem Yavuz Street No: 1 Umraniye, Istanbul, Turkey
| | - Metin Yucel
- Department of General Surgery, Umraniye Training and Research Hospital, Adem Yavuz Street No: 1 Umraniye, Istanbul, Turkey.
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Zhou Y, Ge Y, Liu J, Shen W, Gu H, Cheng G. Modified Frailty Index and Albumin-Fibrinogen Ratio Predicts Postoperative Seroma After Laparoscopic TAPP. Clin Interv Aging 2023; 18:1397-1403. [PMID: 37637752 PMCID: PMC10460205 DOI: 10.2147/cia.s418338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Accepted: 08/08/2023] [Indexed: 08/29/2023] Open
Abstract
Background Postoperative seroma is the most common minor complication after inguinal hernia repair surgery and can have negative consequences. The objective of this study was to identify potential risk factors for postoperative seroma. Methods This study consecutively included 354 elderly patients with inguinal hernia who underwent laparoscopic Transabdominal preperitoneal Patch Plasty (TAPP). Seroma diagnosis was conducted by the same experienced surgeon based on the physical examinations combined with ultrasound. Risk factors for seroma were identified through univariate analysis and subsequently included in the binary multivariate logistic regression model. Results A total of 40 patients experienced postoperative complications of seroma, with an incidence rate of 11.3% (40/354). The binary logistic regression analysis revealed that obesity (OR: 2.98, 95% CI: 1.20-7.41, P = 0.018), disease duration ≥ 4.5 years (OR: 4.88, 95% CI: 2.14-11.18, P < 0.001), albumin-fibrinogen ratio (AFR) level < 9.25 (OR: 6.13, 95% CI: 2.00-18.76, P = 0.001), and modified frailty index (mFI) score ≥ 0.225 (OR: 6.38, 95% CI: 2.69-15.10, P < 0.001) were four independent risk factors for postoperative seroma. Conclusion Obesity, prolonged disease duration, decreased AFR level, and increased mFI score independently predict postoperative seroma after laparoscopic TAPP.
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Affiliation(s)
- Yang Zhou
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Yongxiang Ge
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Jian Liu
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Weijian Shen
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Hailiang Gu
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
| | - Guochang Cheng
- Department of Hernia and Pediatric Surgery, Taizhou People’s Hospital, Taizhou Clinical Medical School of Nanjing Medical University, Taizhou City, Jiangsu Province, 225300, People’s Republic of China
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Liu L, Hu J, Zhang T, Zhang C, Wang S. Influence of the hernia sac treatment method on the occurrence of seroma after laparoscopic transabdominal preperitoneal hernia repair. Asian J Surg 2023; 46:718-722. [PMID: 35864042 DOI: 10.1016/j.asjsur.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/10/2022] [Accepted: 07/06/2022] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To determine whether transection of the hernia sac during laparoscopic transabdominal preperitoneal hernia repair (TAPP) affects the occurrence of seroma, and to explore the risk factors for seroma. METHODS In total, 330 consecutive male patients with indirect inguinal hernia who underwent TAPP repair at the Qingdao University Affiliated Hospital from January 2020 to June 2021 were retrospectively enrolled in this study. According to the intraoperative hernia sac treatment, patients were divided into a completely reduced sac group and a transected sac group. RESULTS Among the 330 inguinal hernia male patients, 240 received hernia sac reduction and 90 received hernia sac transection. Fifty-four patients developed seroma, with an incidence of 16.4%. In patients with a hernia defect measuring ≥3 cm and extension into the scrotum, the difference in the incidence of seroma between the two treatment groups approached significance (P = 0.052). The risk factors for seroma, high body mass index, hernia sac ≥3 cm, extension of the hernia into the scrotum and operation time were significantly associated with postoperative seroma. CONCLUSION This study showed that the incidence of seroma after TAPP was as high as 16.4%. For patients with a hernia sac that is too large and descended extends into the scrotum, transection may be better than complete dissection of the hernia sac and preventive measures should be taken for patients with high body mass index, hernia sac measuring ≥3 cm, and a high risk of the hernia extending into the scrotum.
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Affiliation(s)
- Lei Liu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Jilin Hu
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Tinglong Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Chao Zhang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China
| | - Shouguang Wang
- Department of Gastroenterology, The Affiliated Hospital of Qingdao University, Qingdao, 266003, China.
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Vitagliano T, Garieri P, Lascala L, Ferro Y, Doldo P, Pujia R, Pujia A, Montalcini T, Greco M, Mazza E. Preparing Patients for Cosmetic Surgery and Aesthetic Procedures: Ensuring an Optimal Nutritional Status for Successful Results. Nutrients 2023; 15:nu15020352. [PMID: 36678221 PMCID: PMC9867292 DOI: 10.3390/nu15020352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 01/02/2023] [Accepted: 01/05/2023] [Indexed: 01/12/2023] Open
Abstract
Aesthetic and cosmetic medical practices have attracted considerable consumer attention globally. However, possible complications vary and range from mild, self-resolving ecchymoses or edema to more persistent complications. The aim of this review is to identify the nutritional deficits or excesses associated with the major complications of reconstructive surgery, aesthetic surgery, and mini-invasive aesthetic procedures. An additional goal is to provide a bundle of actions for professionals working in the industry in order to reduce the risks of aesthetic procedures and improve the clinical outcomes. Granulomas, hypertrophic scars and keloids, seromas, infections and xerosis, hyperpigmentation, petechiae, livedo reticularis, slower wound healing, and other poor outcomes are frequently associated with nutritional deficiencies. Nutritional status can markedly affect wound healing and tissue repair following surgical interventions, as well as the outcomes of aesthetic and cosmetic medical practices. Professionals working in this industry, therefore, need to consider the nutritional aspects of their patients to obtain the best results.
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Affiliation(s)
- Tiziana Vitagliano
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Pietro Garieri
- Department of Plastic Surgery, Hand Surgery and Reconstructive Microsurgery, Ospedale San Gerardo, 20900 Monza, Italy
| | - Lidia Lascala
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Yvelise Ferro
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Patrizia Doldo
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Roberta Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
| | - Arturo Pujia
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Grecia, 88100 Catanzaro, Italy
| | - Manfredi Greco
- Department of Clinical and Experimental Medicine, University Magna Grecia, 88100 Catanzaro, Italy
| | - Elisa Mazza
- Department of Medical and Surgical Science, University Magna Grecia, 88100 Catanzaro, Italy
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Awad JR, Alkilany MM, Abdelhamid MI. Sclerotherapy versus percutaneous catheter drainage for treatment of post‐mastectomy seroma: How to select? SURGICAL PRACTICE 2022. [DOI: 10.1111/1744-1633.12590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Merchant A, Speck NE, Michalak M, Schaefer DJ, Farhadi J. Comparing Seroma Formation at the Deep Inferior Epigastric Perforator, Transverse Musculocutaneous Gracilis, and Superior Gluteal Artery Perforator Flap Donor Sites after Microsurgical Breast Reconstruction. Arch Plast Surg 2022; 49:494-500. [PMID: 35919555 PMCID: PMC9340184 DOI: 10.1055/s-0042-1751103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Background Seroma formation is the most common donor site complication following autologous breast reconstruction, along with hematoma. Seroma may lead to patient discomfort and may prolong hospital stay or delay adjuvant treatment. The aim of this study was to compare seroma rates between the deep inferior epigastric perforator (DIEP), transverse musculocutaneous gracilis (TMG), and superior gluteal artery perforator (SGAP) donor sites. Methods The authors conducted a retrospective single-center cohort study consisting of chart review of all patients who underwent microsurgical breast reconstruction from April 2018 to June 2020. The primary outcome studied was frequency of seroma formation at the different donor sites. The secondary outcome evaluated potential prognostic properties associated with seroma formation. Third, the number of donor site seroma evacuations was compared between the three donor sites. Results Overall, 242 breast reconstructions were performed in 189 patients. Demographic data were found statistically comparable between the three flap cohorts, except for body mass index (BMI). Frequency of seroma formation was highest at the SGAP donor site (75.0%), followed by the TMG (65.0%), and DIEP (28.6%) donor sites. No association was found between seroma formation and BMI, age at surgery, smoking status, diabetes mellitus, neoadjuvant chemotherapy, or DIEP laterality. The mean number of seroma evacuations was significantly higher in the SGAP and the TMG group compared with the DIEP group. Conclusion This study provides a single center's experience regarding seroma formation at the donor site after microsurgical breast reconstruction. The observed rate of donor site seroma formation was comparably high, especially in the TMG and SGAP group, necessitating an adaption of the surgical protocol.
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Affiliation(s)
- Alisha Merchant
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole E Speck
- Plastic Surgery Group, Zurich, Switzerland.,Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Michal Michalak
- Department of Computer Science and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Dirk J Schaefer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Jian Farhadi
- Plastic Surgery Group, Zurich, Switzerland.,University of Basel, Basel, Switzerland
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Ali R, Patel A, Abbas A, Hussain M, Slim J, Boghossian J. Persistent Methicillin-Resistant Staphylococcus Aureus Bacteremia Secondary to Infected Seroma: A Rare Case Report. Cureus 2022; 14:e22390. [PMID: 35371705 PMCID: PMC8937040 DOI: 10.7759/cureus.22390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2022] [Indexed: 11/06/2022] Open
Abstract
A seroma is defined as a serous fluid collection that develops as a response to injury and surgeries, particularly mastectomy and reconstructive and abdominal surgeries. The majority of the seromas are self-limiting and arise in the acute postoperative period; however, diagnosis of seroma several years after surgery has also been reported in the literature. Persistent bacteremia with infected seroma as a source is a rare entity. We present the first case to be reported of persistent bacteremia secondary to infected seroma with septic emboli to lungs and prostate without any evidence of endocarditis on multiple echocardiograms. This case highlights the importance of meticulous physical examination and source control in the management of bacteremia.
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Ng K, Teo A. Double Whammy: Rare Case of Infected Chronic Seroma Due to Bacterial Translocation From Biliary Sepsis. Cureus 2021; 13:e19044. [PMID: 34853759 PMCID: PMC8608673 DOI: 10.7759/cureus.19044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2021] [Indexed: 11/05/2022] Open
Abstract
We present a case of infected chronic seroma post ventral hernia repair using the Rives-Stoppa technique likely from bacterial translocation from ascending cholangitis. After definitive treatment with endoscopic retrograde cholangiopancreatography (ERCP) and drainage of obstructed gallstones, she continued to show signs of sepsis. Percutaneous drainage of seroma was diagnostic for infection, where Escherichia coli (E. coli) was cultured and coupled with IV antibiotics, her infection was treated. To the best of our knowledge, this is the first case of seroma infection from biliary sepsis, and there are no cases of infected seroma from a secondary infection in the literature.
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Affiliation(s)
- Katrina Ng
- General Surgery, Sir Charles Gairdner Hospital, Perth, AUS
| | - Adrian Teo
- General Surgery, Armadale Health Service, Perth, AUS
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USE OF PLATELETS RICH PLASMA AS A FACTOR OF THE REDUCTION OF THE RISK OF EARLY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH POSTOPERATIVE VENTRAL HERNIAS. EUREKA: HEALTH SCIENCES 2019. [DOI: 10.21303/2504-5679.2019.00957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Non-tensioned allohernioplasty with a polypropylene mesh implant has several disadvantages associated with the local occurrence of non-specific long-lasting inflammatory reactions in response to a foreign body. Excessive exudation in the implantation zone leads to the formation of seromas, requiring puncture aspiration, which significantly increases the treatment time. In the long-term, chronic prolonged inflammatory process leads to the formation of coarse connective tissue, which explains the development of biomechanical complications. Growth factors, introduced by platelet rich plasma (PRP), stimulate the release of regenerative cytokines, reduce local inflammatory manifestations in the integration of homoplastic grafts and reduce the incidence of postoperative complications.
Aim: through the use of plasma enriched with platelets reduce the severity of early postoperative complications in patients with postoperative ventral hernias.
Materials and methods. A clinical study was performed in the surgical department of the center for reconstructive and restorative medicine (university clinic) of the Odessa National Medical University (ONMedU) in the period from 2013 to 2019: 84 patients were operated because of postoperative ventral hernia. The average age of patients was 60.1±7.6 years. The size of hernial defects was on average 8.2 cm. The average BMI was 31.8 kg/m2. According to indications, patients underwent a standard surgical extent of intervention: hernia repair, allohernioplasty of the anterior abdominal wall with a lightweight (80 g/m2) polypropylene implant. After the plastics of the main group, a prosthesis implantation zone was infiltrated with activated autologous PRP, which was prepared by double centrifugation, in a volume of 14–38 ml. There was a control group in which PRP infiltration was not performed. The cavity above the mesh implant was actively drained by Redon for 2–4 days. An ultrasound examination was performed and, if necessary, fine needle aspiration of serous fluid over the mesh was done.
Results. The evaluation of the postoperative period (up to 28 days) in patients of both groups. In none of the cases were manifestations of allergic, pyrogenic, local inflammatory or infectious complications. According to the quantitative assessment of early postoperative complications as well as the assessment of the degree of pain syndrome subjectively, according to VAS, the postoperative period in the main and control study groups was almost identical. The need for puncture aspirations and the total volume of discharge was significantly less in the main study group. The dependence of the severity of the effect of the proposed technology on such factors as the size of the hernial defect, the nature of plastics, and body mass index was noted. The greatest efficacy was demonstrated in the group of patients undergoing plastic surgery with the placement of a mesh implant in direct contact with subcutaneous fatty tissue for large-sized hernias (W2+) in the presence of concomitant obesity.
Conclusions: the risk of development and the severity of fluid accumulations in the area of allohernioplasty can be predicted taking into account such risk factors as the size of the hernial defect, the nature of plastics, the presence of concomitant pathology, overweight. The technique of soft tissue infiltration in contact with a polypropylene prosthesis is safe, without significantly increasing the risk of local or systemic complications. The proposed method significantly reduces the risk of development and the severity of fluid accumulations in the area of implantation of the prosthesis. The effectiveness of technology is significantly higher compared to groups of patients with a high risk of seromas formation.
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Correlation between laparoscopic transection of an indirect inguinal hernial sac and postoperative seroma formation: a prospective randomized controlled study. Surg Endosc 2018; 33:1147-1154. [PMID: 30327912 DOI: 10.1007/s00464-018-6374-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Seroma is the most common early minor complication of inguinal hernia repair. Seromas generally resolve spontaneously within a few weeks, but can sometimes cause other complications. The optimal ways to repair inguinal hernia and handle the hernial sac are still debatable. Large scale, prospective, randomized, controlled studies focusing on the correlation between transection of the hernial sac and seroma formation are scarce. METHODS A total of 159 adult male patients with primary indirect inguinal hernia who underwent laparoscopic transabdominal preperitoneal repair were recruited. The patients were randomized to undergo either complete dissection or transection of the hernial sacs. Patients were followed up at postoperative 7 days, 1 and 3 months, looking specifically for seroma. Seroma was diagnosed via physical examination, and a prestructured form was used to evaluate patient recovery and define the type of seroma present at each follow-up visit. RESULTS There were 83 patients in the completely dissected group and 76 in the transected group. The overall incidence of postoperative seroma was 12.6% (n = 20). The χ2 test demonstrated that significantly more patients developed seroma in the transected group than in the completely dissected group (18.4% vs. 7.2%, p = 0.034); there were also significant differences between the two groups in the incidences of seroma at postoperative 7 days (18.4% vs. 6.0%, p = 0.016) and 1 month (14.5% vs. 4.8%, p = 0.037). Seroma formation was correlated with age, body mass index, use of anticoagulants, hernia type, hernia size, sac size, and operative time. There were no significant differences between the two groups in the degree of postoperative pain and time taken for the resumption of outdoor activities. CONCLUSIONS When using the laparoscopic transabdominal preperitoneal technique for indirect inguinal hernia repair, the risk of postoperative seroma formation is greater after transection compared with complete dissection of the hernial sac.
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Juo YY, Skancke M, Holzmacher J, Amdur RL, Lin PP, Vaziri K. Laparoscopic versus open ventral hernia repair in patients with chronic liver disease. Surg Endosc 2016; 31:769-777. [PMID: 27334967 DOI: 10.1007/s00464-016-5031-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 06/11/2016] [Indexed: 02/07/2023]
Abstract
BACKGROUND Previous studies demonstrated laparoscopic ventral hernia repair (LVHR) to be associated with fewer short-term complications than open ventral hernia repair (OVHR). Little literature is available comparing LVHR and OVHR in chronic liver disease (CLD) patients. METHODS Patients with model for end-stage liver disease score ≥9 who underwent elective ventral hernia repair in the National Surgical Quality Improvement Program Database were included. 30-day outcomes were compared between LVHR and OVHR after adjusting for hernia disease severity, baseline comorbidities and demographic factors. RESULTS A total of 3594 ventral hernia repairs were included, 536 (14.9 %) of which were LVHR. After adjusting for other confounders, LVHR was associated with a lower incidence of wound-related complications (0.23, 95 % CI 0.07-0.74, p = 0.01), shorter length of stay (mean 3.7 vs. 5.0 days, p < 0.01) than OVHR, but similar systemic complications (p = 0.77), bleeding complications (p = 0.69), unplanned reoperation (p = 0.74) or readmission (p = 0.40). Propensity score-matched comparison showed similar conclusions. Five hundred and sixty-two patients had ascites, among whom 35 (6.2 %) underwent LVHR. In this subcohort, LVHR was associated with higher mortality (OR 5.36, 95 % CI 1.00-28.60, p = 0.05), systemic complications (OR 7.03, 95 % CI 2.06-24.00, p < 0.01), and unplanned reoperation (OR 6.03, 95 % CI 1.51-24.12, p = 0.01) than OVHR. CONCLUSIONS In comparison with OVHR, LVHR is associated with similar short-term outcomes except for lower wound-related complications and shorter length of stay in CLD patients. However, when patients have ascites, LVHR is associated with higher mortality, systemic complications, and unplanned reoperation.
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Affiliation(s)
- Yen-Yi Juo
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA.
| | - Matthew Skancke
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA
| | - Jeremy Holzmacher
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA
| | - Richard L Amdur
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA
| | - Paul P Lin
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA
| | - Khashayar Vaziri
- Department of Surgery, George Washington University Medical Center, 22nd and I Street, NW, 6th Floor, Washington, DC, 20037, USA
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Sukhovatykh BS, Valuyskaya NM, Pravednikova NV, Gerasimchuk EV, Mutova TV. [Prevention of postoperative ventral hernias: current state of the art]. Khirurgiia (Mosk) 2016:76-80. [PMID: 27222909 DOI: 10.17116/hirurgia2016376-80] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
| | - N M Valuyskaya
- Chair of General Surgery, Kursk State Medical University
| | | | | | - T V Mutova
- Chair of General Surgery, Kursk State Medical University
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Pascual G, Sotomayor S, Rodríguez M, Bayon Y, Bellón JM. Tissue integration and inflammatory reaction in full-thickness abdominal wall repair using an innovative composite mesh. Hernia 2015; 20:607-22. [PMID: 25903676 DOI: 10.1007/s10029-015-1383-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 04/11/2015] [Indexed: 01/31/2023]
Abstract
PURPOSE When composite meshes are used in abdominal wall repair, seroma formation may persist and delay the desired integration leading to recurrence. This study compares tissue integration and inflammatory response in abdominal wall repair with composites with different absorbable synthetic barriers. METHODS Full-thickness defects created in the abdominal wall of rabbits were repaired using polypropylene prosthesis or the following composites: Physiomesh™ (Phy); Ventralight™ (Vent) and "new composite mesh" (Ncm) not yet used clinically in humans. The collected seroma was evaluated for IFN-γ/IL-4 by ELISA. Tissue integration, anti- (IL-13/TGFβ-1/IL-10/IL-4) and pro-inflammatory (TNF-α/IL-6/IFN-γ/VEGF) cytokine mRNA expression and TGFβ/VEGF immunolabeling were evaluated at 14 and 90 days post-implant. RESULTS Seroma was observed in 10 of 12 Phy/Vent and 4 of 12 Ncm. Wound fluid IFN-γ showed a time-dependent significant increase in Vent and tendency to decrease in Ncm, while all composites exhibited IL-4 upward trend. Prostheses were fully infiltrated by an organized connective tissue at end time although the area had shown prior seroma. A stable mesothelium was developed, except in adhesion areas. Vent/Phy displayed a significant increase in TNF-α/IFN-γ-mRNA over time. Significant decrease in VEGF mRNA was observed in Phy/Ncm, while a significant increase of TGFβ-1 mRNA was evident in all composites over time. Ncm exhibited the highest TGFβ protein expression area at short term and the greatest percentage of VEGF positive vessels at end time. CONCLUSION Ncm could be an appropriate candidate to improve clinical outcome showing the lower development of seroma and optimal tissue integration with minimal pro-inflammatory cytokine response over time and consistent pro-wound healing cytokine expression.
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Affiliation(s)
- G Pascual
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km 33,600, 28871, Alcalá De Henares, Madrid, Spain. .,Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain.
| | - S Sotomayor
- Department of Medicine and Medical Specialties, Faculty of Medicine and Health Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km 33,600, 28871, Alcalá De Henares, Madrid, Spain.,Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - M Rodríguez
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km 33,600, 28871, Alcalá De Henares, Madrid, Spain.,Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
| | - Y Bayon
- Covidien-Sofradim Production, 116 Avenue du Formans, 01600, Trévoux, France
| | - J M Bellón
- Department of Surgery, Medical and Social Sciences, Faculty of Medicine and Health Sciences, University of Alcalá, Ctra. Madrid-Barcelona, Km 33,600, 28871, Alcalá De Henares, Madrid, Spain.,Networking Research Centre on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Madrid, Spain
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Negative-pressure therapy in the postoperative treatment of incisional hernioplasty wounds: a pilot study. Adv Skin Wound Care 2015; 27:77-80. [PMID: 24440865 DOI: 10.1097/01.asw.0000442873.48590.b5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Negative pressure therapy has proven useful in the treatment of the complex complications of surgical wounds. In this pilot study, the authors found that the negative pressure system can be used safely in the postoperative period of incisional hernia surgery and reduces the number of days of drainage.
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Vasilakis V, Cook K, Wilson D. Surgical resection and scarification for chronic seroma post-ventral hernia mesh repair. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:526-9. [PMID: 25430512 PMCID: PMC4259519 DOI: 10.12659/ajcr.891346] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Patient: Male, 52 Final Diagnosis: Seroma Symptoms: Abdominal discomfort • abdominal mass Medication: — Clinical Procedure: Excision and evacuation of the complex seroma Specialty: Surgery
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Affiliation(s)
- Vasileios Vasilakis
- Department of General Surgery, Morristown Memorial Hospital, Morristown, USA
| | - Kristin Cook
- Department of Surgery, Rutgers New Jersey Medical School, Newark, USA
| | - Dorian Wilson
- Department of Surgery, Rutgers New Jersey Medical School, Newark, USA
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Acute inflammatory response in the subcutaneous versus periprosthethic space after incisional hernia repair: an original article. BMC Surg 2014; 14:91. [PMID: 25399250 PMCID: PMC4247657 DOI: 10.1186/1471-2482-14-91] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 10/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The acute inflammatory response following mesh implantation has been often evaluated in vitro and in animal models. The aim of this study was to evaluate the acute inflammatory response near the prosthesis in human by analysing some inflammatory indicators. METHODS We used a cohort of twelve male patients affected by midline incisional hernia, who were admitted for surgical mesh repair. A suction drain was placed between the mesh and rectal muscles whereas, the other one was placed between the subcutaneous tissue and the oblique external sheath. The acute inflammatory response was analyzed by measuring the production of interleukin [IL]-1, IL-10, IL-1ra, C-Reactive Protein (CRP), total proteins, albumin and pH in the drain fluids. RESULTS The dynamics of CRP and ILs production resulted similar in both drainages. Comparing drain over mesh and subcutaneous drain at all times, IL-1 and CRP values always resulted significantly higher in the first one, whereas IL-1ra and IL-10 values were significantly higher in the last one. Total protein and albumin were similar in both drains at all time; only in the drain over mesh fluid, pH values resulted significantly reduced in the fourth post-operative day. CONCLUSIONS Our data showed that an acute inflammatory reaction is present in both sites examined. However, it was significantly higher in the space after mesh implantation.
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Christoffersen MW, Olsen BH, Rosenberg J, Bisgaard T. Randomized Clinical Trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. Hernia 2014; 19:147-53. [DOI: 10.1007/s10029-014-1289-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022]
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Al-Gaithy ZK, Ayuob NN. Vascular and cellular events in post-mastectomy seroma: an immunohistochemical study. Cell Immunol 2011; 272:130-6. [PMID: 22138500 DOI: 10.1016/j.cellimm.2011.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Revised: 10/09/2011] [Accepted: 10/28/2011] [Indexed: 10/15/2022]
Abstract
This study aimed to describe the vascular and cellular histopathological changes that occurred in post-mastectomy seroma in an animal model. Unilateral mastectomies were conducted on 45 female albino rabbits. On day seven, the skin flap and the underlying tissues of the mastectomy regions were dissected and processed for histopathological examination using immunohistochemical staining of the T- and B-lymphocytes and macrophages (CD3, CD20, and CD68 respectively), and the vascular endothelia. The post-mastectomy regions in the seroma group showed a large number of inflammatory cells and newly formed blood vessels that lost the integrity of their endothelial cell linings, as revealed by the von Willebrand factor staining, as well the basement membrane, as revealed by the histochemical stain. The post-mastectomy seroma beds showed many CD3 and CD20+ve lymphocytes and CD68+ve macrophages. These macrophages were producing angiogenic factors, resulting in the persistent and continuous formation of new blood vessels. These new blood vessels were defective and represented an underlying cause of seroma formation.
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López-Cano M, Armengol-Carrasco M. Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation. Hernia 2011; 17:129-31. [DOI: 10.1007/s10029-011-0837-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Accepted: 05/29/2011] [Indexed: 10/18/2022]
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