Seroma in laparoscopic ventral hernioplasty

Seroma is a frequent complication of laparoscopic or open repair of ventral hernias using expanded polytetrafluoroethylene mesh. Aspiration of this se roma has the risk of introducing bacteria, resulting in infection and the r ecurrence of the hernia. Between May 1996 and December 2000, 51 patents who underwent 53 laparoscopic ventral hernioplasties (44 incisional, 5 large e pigastric, and 4 large umbilical) were randomized to participate in a trial comparing the intraperitoneal onlay mesh repair with or without cauterizat ion of the hernia sac. Group A (26 patients; 28 hernias) patients were oper ated on by using an expanded polytetrafluoroethylene Dual Mesh patch (Gore and Associates, Flagstaff, AZ, U.S.A.) inserted intraperitoneally and secur ed by full-thickness stitches and endoscopic clips to cover the hernia defe ct, while the sac was left intact. Group B (25 patients, 25 hernias) patien ts were operated on according to the same technique as those in group A, bu t the hernia sac was cauterized. by monopolar cautery (5 cases) or harmonic scalpel (20 cases). After surgery, clinical examination and computed tomog raphy scans were used to confirm or test the existence of seroma and recurr ence. In group A, four clinically evident seromas were found. Two of them w ere resolved with no intervention. In the remaining two cases, multiple asp irations were needed for 4 and 7 months, respectively, but 2 and 3 months, respectively, after resolution of the seroma, a recurrence of the hernia wa s observed. There was one more recurrence without seroma and three with sub clinical 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 caute rization of the hernia sac prevents seromas and reduces recurrences in lapa roscopic repair of ventral hernias.