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Intraoperative hypertonic saline irrigation preventing seroma formation and reducing drain secretion in extended endoscopic hernia and linea alba reconstruction glue

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Abstract

Purpose

Subcutaneous Seroma formation (SF) is commonly seen after abdominal wall Hernia surgeries and reconstructive surgeries due to large dissecting dead space and is associated with increased morbidity. SF is common particularly after big abdominal wall hernia repairs and its treatment can be challenging and long. Current prevention methods are not consistent and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of Intraoperative Hypertonic Saline Irrigation (IHSI) to abdominal wall subcutaneous large dead space, which prevent postoperative SF and enables early drain removal due to reduced secretions.

Methods

Eight patients undergone the Extended Endoscopic Hernia & Linea Alba Reconstruction Glue surgery (eEHLARglue), for Ventral Hernias (VH) and Rectus Muscles Separation (RMS). An extensive Endoscopic 450cm2 dissection free surface of the anterior Rectus fascia, is performed prior to Hernia dissection and closing of the RMS. It is followed by onlay mesh placing over the repaired Rectus muscles and the mesh is fused into the muscles by Fibrin Glue. The novel preventive method is based on Intraoperative Irrigation of the vast cavity through the two 10 mm JP closed system drains with 20 cc of NaCl 12% left at site for 10 min.

Results

Our early results with all our patients show seroma prevention, lower secretion rate of 20 cc in 10 h and drain removal within 20–24 h.

Conclusions

IHSI enhance adhesion formation and reduce secretion rate in wide subcutaneous dissection space like in eEHLARglue, therefore enables early drain removal and prevent SF. As a result, reducing overall morbidity and hospitalization period, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This simple technique could be used in other potential postoperative SF surgeries. Further larger study with a longer follow up is advised.

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Abbreviations

IHSI:

Intraoperative hypertonic saline irrigation

HS:

Hypertonic saline

SF:

Seroma formation

eEHLARglue:

Extended endoscopic hernia and linea alba reconstruction glue

RMS:

Rectus muscles separation

VH:

Ventral hernia

References

  1. Janis JE, Khansa L, Khansa I (2016) Strategies for postoperative seroma prevention: a systematic review. Plast Reconstr Surg 138:240–252

    Article  CAS  Google Scholar 

  2. Carless PA, Henry DA (2006) Systematic review and meta-analysis of the use of fibrin sealant to prevent seroma formation after breast cancer surgery. Br J Surg 93(7):810–819

    Article  CAS  Google Scholar 

  3. Kumar S, Lal B, Misra MC (1995) Post-mastectomy seroma: a new look into the aetiology of an old problem. J R Coll Surg Edinb 40:292–294

    CAS  PubMed  Google Scholar 

  4. Woodworth PA, McBoyle MF, Helmer SD, Beamer RL (2000) Seroma formation after breast cancer surgery; incidence and predicting factors. Am Surg 66(5):444–450

    CAS  PubMed  Google Scholar 

  5. Johns N, Fairbairn N, Trail M, Ewing A, Yong L, Raine C et al (2018) Autologous breast reconstruction using the immediately lipofilled extended latissimus dorsi flap. J Plast Reconstr Aesthet Surg 71(2):201–208

    Article  CAS  Google Scholar 

  6. Thacoor A, Kanapathy M, Torres-Grau J, Chana J (2018) Deep inferior epigastric perforator (DIEP) flap: impact of drain free donor abdominal site on long term patient outcomes and duration of inpatient stay. J Plast Reconstr Aesthet Surg 71(8):1103–1107

    Article  Google Scholar 

  7. Triana L, Triana C, Barbato C, Zambrano M (2009) Liposuction: 25 years of experience in 26,259 patients using different devices. Aesthet Surg J 29(6):509–512

    Article  Google Scholar 

  8. Seretis K, Goulis D, Demiri EC, Lykoudis EG (2017) Prevention of seroma formation following abdominoplasty: a systematic review and meta-analysis. Aesthet Surg J 37(3):316–323.

    Article  Google Scholar 

  9. Susmallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia 5:139–141

    Article  CAS  Google Scholar 

  10. Morales-Conde S, Suarez-Artacho G, Socas-Macias M, Barranco-Moreno A (2015) Retroprosthetic seroma after laparoscopic ventral hernia repair: incidence, risk factors and clinical significance. Hernia 19(6):943–947

    Article  CAS  Google Scholar 

  11. Sood A, Kotamarti VS, Therattil PJ, Lee ES (2017) Sclerotherapy for the management of seromas: a systematic review. Eplasty 28(17):e25

    Google Scholar 

  12. van Bastelaar J, Granzier R, van Roozendaal LM, Beets G, Dirksen CD et al (2018) A multi-center, double blind randomized controlled trial evaluating flap fixation after mastectomy using sutures or tissue glue versus conventional closure: protocol for the Seroma reduction After Mastectomy (SAM) trial. BMC Cancer 18:830

    Article  Google Scholar 

  13. Kontos M, Petrou A, Prassas E, Tsigris C, Roy P, Trafalis D, Bastounis E, Karamanakos P (2008) Pressure dressing in breast surgery: is this the solution for seroma formation? J BUON 13(1):65–67

    CAS  PubMed  Google Scholar 

  14. Lee KT, Mun GH (2015) Fibrin sealants and quilting suture for prevention of seroma formation following latissimus dorsi muscle harvest: a systematic review and meta-analysis. Aesthetic Plast Surg 39(3):399–409

    Article  Google Scholar 

  15. Piñero-Madrona A, Castellanos-Escrig G, Abrisqueta-Carrión J, Canteras-Jordana M (2016) Prospective randomized controlled study to assess the value of a hemostatic and sealing agent for preventing seroma after axillary lymphadenectomy. J Surg Oncol 114(4):423–427

    Article  Google Scholar 

  16. Plymale MA, Harris JW, Davenport DL, Smith N, Levy S, Scott Roth J (2016) Abdominal wall reconstruction: the uncertainty of the impact of drain duration upon outcomes. Am Surg 82(3):207–211

    PubMed  Google Scholar 

  17. Hanna KR, Tilt A, Holland M, Colen D, Bowen B, Stovall M, Lee A, Wang J, Drake D, Lin K, Uroskie T, Campbell CA (2016) Reducing infectious complications in implant based breast reconstruction: impact of early expansion and prolonged drain use. Ann Plast Surg 76(Suppl 4):S312–S315

    Article  CAS  Google Scholar 

  18. Dudai M (2017) Endoscopic-Assisted Linea Alba Reconstruction (ELAR) – New technique for All Ventral Hernias in combination with Diastasis Rectaii –Abdominal Muscles Separation. The Biannual congress of The Israel Surgical Society, Kfar Blum

    Google Scholar 

  19. Dudai M (2018) March) extended endoscopic linea alba reconstruction glue (eELARG)—new technique for ventral hernias in combination with diastasis recti –abdominal muscles separation. Hernia 22(Suppl 1):S185

    Google Scholar 

  20. Dudai M (2018) Changing in the Lap setup; you do not need a robot for having a good ergonomic position, just take a Chair. Barracuda Tank Session 2018. American Hernia Society International Hernia Congress, Miami

    Google Scholar 

  21. Dudai M (2018) Changing in the lap setup; lap. Sitting position—LSP. Amazing technology session. European Association for Endoscopic Surgery Congress, London

    Google Scholar 

  22. Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty. Surg Endosc 17(11):1773–1777

    Article  CAS  Google Scholar 

  23. Maciej Śmietański (2019) Personal communication: Gdansk Poland, smietana@gumed.edu.pl

  24. Albanese G, Kondo KL (2010) Pharmacology of Sclerotherapy. Semin Intervent Radiol 27(4):391–399

    Article  Google Scholar 

  25. Gage TP, Vivian G (1984) Hypernatremia after hypertonic saline irrigation of and hepatic hydatid cyst. Ann Intern Med 101(3):405

    Article  CAS  Google Scholar 

  26. Peterson JD, Goldman MP, Weiss RA, Duffy DM, Fabi SG, Weiss MA, Guiha I (2012) Treatment of reticular and telangiectatic leg veins: double-blind, prospective comparative trial of polidocanol and hypertonic saline. Dermatol Surg 38(8):1322–30.

    Article  CAS  Google Scholar 

  27. Gruver DI (2003) Hypertonic saline for treatment of seroma. Plast Reconstr Surg 112(3):934

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, MERAV Medical Center, Bat-Yam, Israel

    M. Dudai & K. Gilboa Ittah

  2. Hernia Excellence, Tel-Aviv, Israel

    M. Dudai

Authors
  1. M. Dudai
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  2. K. Gilboa Ittah
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Correspondence to M. Dudai.

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Approval from the institutional review board was not required for this study.

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The study including Human participants has been performed in accordance with the ethical standards of the Declaration of Helsinki and its later amendments.

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Dudai, M., Gilboa Ittah, K. Intraoperative hypertonic saline irrigation preventing seroma formation and reducing drain secretion in extended endoscopic hernia and linea alba reconstruction glue. Hernia 23, 1291–1296 (2019). https://doi.org/10.1007/s10029-019-01956-2

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