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