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Intra-operative adjuncts used during open
incisional hernia repair to reduce seroma
formation: a systematic review
Miss Lisa Massey Colorectal registrar
I have no commercial disclosures.
WHAT IS A SEROMA?
“collection of serous fluid in
a body cavity, organ or
tissue, which occurs
following surgery or
trauma”
Farlex Medical Dictionary 2009
AIM
• Evaluate intraoperative adjuncts used to reduce seroma
formation in open incisional hernia repair
• Primary outcome: seroma formation
• Secondary outcome: hernia recurrence
METHODS
Literature search
• Databases: PubMed and Embase
• Dates: 1947 – 2017
• Search terms: incisional hernia
abdominal wall hernia
ventral hernia
mesh
seroma
METHODS
Inclusion Exclusion
Peer-reviewed publications Duplicates/duplicated data set
Comparative human studies Laparoscopic repair
At least one intervention Prophylactic mesh placement/other
abdominal wall hernias
Contains seroma as an outcome < 18yrs old
Non-English language
<5 patients in each group
PRISMA
ADJUNCTS
• Negative pressure wound
therapy (NPWT)
• Medical talc
• Fibrin sealant
• Quilting sutures
• Subcutaneous suction drains
NEGATIVE PRESSURE WOUND
THERAPY (NPWT)
Soares KC et al, Am J Surg 2015 Conde-Green et al, Ann Plast Surg 2015
With wicks Soares KC et al, Am J Surg 2015
Without wicks Conde-Green et al, Ann Plast Surg 2015
NEGATIVE PRESSURE WOUND THERAPY
(NPWT) With wicks Without wicks
MEDICAL TALC
FIBRIN SEALANT
QUILTING SUTURES
Sforza et al, Aesthet J Surg 2015
SUCTION DRAINS
NPWT
Study NPWT Control Seroma NPWT Seroma Control Recurrence NPWT
Recurrence Control MINORS score
Condé-Green
23 33 0% 12%
p = 0.14
4.3% 9.1%
p = 0.63
12
Gassman 29 32 9.4% 10.3%
p = 1
3.4 % 21.9%
p = 0.05
15
Olona 5 37 0% 13%
p = 1
N/A N/A 8
Soares 115 84 7% 11%
p = 0.35
2% 5%
p = 0.13
15
Massey et al, Hernia, under submission 2017
NPWT META-ANALYSIS
MEDICAL TALC
Study Talc Control Seroma talc Seroma control Recurrence talc Recurrence
control
MINORS score
Klima 74 106 2.7% 20.8%
p < 0.001
0% 11%
p = 0.005
16
Parameswaran 21 116 76% 9.5%
p = 0.001
N/A N/A 12
MEDICAL TALC
Klima et al
Sublay mesh
Parameswaran et al
Onlay mesh
4 - 8g
aerosolised
8 - 16g
slurry
FIBRIN SEALANT
Study Fibrin sealant Control Seroma fibrin
sealant
Seroma
control
Recurrence
fibrin sealant
Recurrence
control MINORS
score
Azoury 127 123 11% 4.9%
p = 0.07
4.3% 4.2%
p = 0.99 12
Köhler 30 30 3.3% 23%
p <0.001
N/A N/A 15
FIBRIN SEALANT
Kohler et al
Sublay mesh
Azoury et al
Onlay mesh
Spray
4 IU thrombin/ml per
20cm2 defect area
Droplet
500 IU thrombin/ml
per 5cm2 defect area
QUILTING SUTURES VS DRAINS
Study Drains Quilting sutures Seroma drains Seroma quilting sutures
Westphalen 21 21 48% 57% (p = 0.86)
DISCUSSION
Lack of standardised reporting
“Of specific interest for abdominal wall
surgery is postoperative seroma. The
seroma classification proposed by
Morales-Conde is recommended.”
CONCLUSIONS
• No intervention
• Surgical technique
• Standardised reporting
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