, Volume 16, Issue 3, pp 261–267 | Cite as

A new classification for seroma after laparoscopic ventral hernia repair

  • S. Morales-Conde



Laparoscopic techniques are being used increasingly in the repair of ventral hernias, but different incidences and complications have been described as potential risks of this approach. Seroma formation has been documented as one of the most common complication, although most of the time remains asymptomatic and it can be considered just an incident. The incidence of seroma after laparoscopic ventral hernia repair has not been properly documented and analyzed since the definition used by different authors is not the same from one series to another. We present a new classification of clinical seroma in order to try to establish the real incidence of this potential complication.

Clinical classification

Clinical seromas could be detected during physical examination in many patients after LVHR, but in most of the cases they do not cause any problem or just a minimum discomfort that allows normal activity. Based on this fact and on the need of carrying out a medical or an invasive therapy to treat them, five groups can be established in order to classified this entity: Type 0, no clinical seroma (being 0a no seroma after clinical examination and radiological examinations and 0b those detected radiologically but not detected clinically); Type I, clinical seroma lasting less than 1 month; Type II (seroma with excessive duration), clinical seroma lasting more than 1 month (being IIa between 1 and 3 months and IIb between 3 and 6 months); Type III (symptomatic seromas that may need medical treatment), minor seroma-related complications (seroma lasting more than 6 month, esthetic complaints of the patient due to seroma, discomfort related to the seroma that does not allow normal activity to the patient, pain, superficial infection with cellulites); and Type IV (seroma that need to be treated), mayor seroma-related complications (need to puncture the seroma, seroma drained spontaneously, applicable to open approach, deep infection, recurrence and mesh rejection). It is important to differentiate between a complication and an incident, being considered seroma as an incident if it is classified as seroma Type I or II, and a complication if it is included in group III and IV. The highest classification is the one that should be used in order to describe the type of seroma.


Seroma is one of the most common complications after laparoscopic ventral hernia repair although its real clinical incidence is variable since it has been described in the literature following different parameters. It is observed in almost all cases by radiological examinations, but it is not determined if must be considered an incident or a complication. For these reasons, a new classification of seroma has been proposed in order to unify criteria among surgeons when describing their experience. This classification could be also used in the future to measure the effect of new methods proposed to reduce seroma formation to evaluate the incidence of seroma depending on the mesh used, and it could be also proposed to be used to describe the incidence of seroma after open ventral hernia repair.


Seroma Laparoscopic Ventral hernia Complication Classification 


  1. 1.
    Morales-Conde S, Abdel-Lah A, Angoso-Catalina F, Blasco F, Feliu-Pala X, Fernandez-Lobato R, Gonzalez de Francisco T, Guerrero Fernandez-Marcote JA, Martin-Gomez M, Martinez-Garcia F, Morales-Mendez S, Murillo J, Oliva H, Pina J, Planellas X, Robres J, Rodero D, Ruiz-Castillo J, Serrantes-Gomez A, Tovar-Martinez JL, Tuca F, Utrera A, GRRETHAL (Grupo Espanol para el Estudio del Tratamiento de las Hernias Abdominales por Laparoscopia) (2005) Expert opinion on the basic surgical technique for laparoscopic ventral hernia repair. Cir Esp 78:214–221PubMedCrossRefGoogle Scholar
  2. 2.
    Misiakos EP, Machairas A, Patapis P, Liakakos T (2008) Laparoscopic ventral hernia repair: pros, cons compared with open hernia repair. JSLS 12:117–125PubMedGoogle Scholar
  3. 3.
    Barbaros U, Asoglu O, Seven R, Erbil Y, Dinccag A, Deveci U, Ozarmagan S, Mercan S (2007) The comparison of laparoscopic, open ventral hernia repairs: a prospective randomized study. Hernia 11:51–56PubMedCrossRefGoogle Scholar
  4. 4.
    Kaafarani HM, Kaufman D, Reda D, Itani KM (2010) Predictors of surgical site infection in laparoscopic, open ventral incisional herniorrhaphy. J Surg Res 163:229–234PubMedCrossRefGoogle Scholar
  5. 5.
    Morales-Conde S (2004) Laparoscopic ventral hernia repair: advances and limitations. Semin Laparosc Surg 11:191–200PubMedGoogle Scholar
  6. 6.
    Schoenmaeckers EJ, Raymakers JF, Rakic S (2010) Complications of laparoscopic correction of abdominal wall, incisional hernias. Ned Tijdschr Geneeskd 154:A2390PubMedGoogle Scholar
  7. 7.
    Cihan A, Ozdemir H, Ucan BH, Acun Z, Comert M, Tascilar O, Cesur A, Cakmak GK, Gundogdu S (2006) Fade or fate. Seroma in laparoscopic inguinal hernia repair. Surg Endosc 20:325–328PubMedCrossRefGoogle Scholar
  8. 8.
    Parker HH III, Nottingham JM, Bynoe RP, Yost MJ (2002) Laparoscopic repair of large incisional hernias. Am Surg 68:530–533PubMedGoogle Scholar
  9. 9.
    Birch DW (2007) Characterizing laparoscopic incisional hernia repair. Can J Surg 50:195–201PubMedGoogle Scholar
  10. 10.
    Bedi AP, Bhatti T, Amin A, Zuberi J (2007) Laparoscopic incisional, ventral hernia repair. J Minim Access Surg 3:83–90PubMedCrossRefGoogle Scholar
  11. 11.
    Susmallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia 5:139–141PubMedCrossRefGoogle Scholar
  12. 12.
    Palanivelu C, Jani KV, Senthilnathan P, Parthasarathi R, Madhankumar MV, Malladi VK (2007) Laparoscopic sutured closure with mesh reinforcement of incisional hernias. Hernia 11:223–228PubMedCrossRefGoogle Scholar
  13. 13.
    Perrone JM, Soper NJ, Eagon JC, Klingensmith ME, Aft RL, Frisella MM, Brunt LM (2005) Perioperative outcomes, complications of laparoscopic ventral hernia repair. Surgery 138:708–715PubMedCrossRefGoogle Scholar
  14. 14.
    Sharma A, Mehrotra M, Khullar R, Soni V, Baijal M, Chowbey PK (2001) Laparoscopic ventral/incisional hernia repair: a single centre experience of 1, 242 patients over a period of 13 years. Hernia 15:131–139CrossRefGoogle Scholar
  15. 15.
    Orenstein SB, Dumeer JL, Monteagudo J, Poi MJ, Novitsky YW (2011) Outcomes of laparoscopic ventral hernia repair with routine defect closure using “shoelacing” technique. Surg Endosc 25:1452–1457PubMedCrossRefGoogle Scholar
  16. 16.
    Rosenberg J, Burcharth J (2008) Feasibility and outcome after laparoscopic ventral hernia repair using proceed mesh. Hernia 12:453–456PubMedCrossRefGoogle Scholar
  17. 17.
    Morales-Conde S, Cadet H, Cano A, Bustos M, Martin J, Morales-Mendez S (2005) Laparoscopic ventral hernia repair without sutures–double crown technique: our experience after 140 cases with a mean follow-up of 40 months. Int Surg 90:S56–S62PubMedGoogle Scholar
  18. 18.
    Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias: nine years′ experience with 850 consecutive hernias. Ann Surg 238:391–399PubMedGoogle Scholar
  19. 19.
    Tessier DJ, Swain JM, Harold KL (2006) Safety of laparoscopic ventral hernia repair in older adults. Hernia 10:53–57PubMedCrossRefGoogle Scholar
  20. 20.
    Kaafarani HM, Hur K, Hirter A, Kim LT, Thomas A, Berger DH, Reda D, Itani KM (2009) Seroma in ventral incisional herniorrhaphy: incidence, predictors, outcome. Am J Surg 198:639–644PubMedCrossRefGoogle Scholar
  21. 21.
    Varnell B, Bachman S, Quick J, Vitamvas M, Ramshaw B, Oleynikov D (2008) Morbidity associated with laparoscopic repair of suprapubic hernias. Am J Surg 196:983–987PubMedCrossRefGoogle Scholar
  22. 22.
    Edwards C, Angstadt J, Whipple O, Grau R (2005) Laparoscopic ventral hernia repair: postoperative antibiotics decrease incidence of seroma related cellulites. Am Surg 71:931–935PubMedGoogle Scholar
  23. 23.
    Sodergren MH, Swift I (2010) Seroma formation, method of mesh fixation in laparoscopic ventral hernia repair—highlights of a case series. Scand J Surg 99:24–27PubMedGoogle Scholar
  24. 24.
    Berrevoet F, Fierens K, De Gols J, Navez B, Van Bastelaere W, Meir E, Ceulemans R (2009) Multicentric observational cohort study evaluating a composite mesh with incorporated oxidized regenerated cellulose in laparoscopic ventral hernia repair. Hernia 13:23–27PubMedCrossRefGoogle Scholar
  25. 25.
    Tsimoyiannis EC, Siakas P, Glantzounis G, Koulas S, Mavridou P, Gossios KI (2001) Seroma in laparoscopic ventral hernioplasty. Surg Laparosc Endosc Percutan Tech 11:317–321PubMedCrossRefGoogle Scholar
  26. 26.
    Appeltans BM, Zeebregts CJ, Cate Hoedemaker HO (2000) Laparoscopic repair of a Spigelian hernia using an expanded polytetrafluoroethylene (ePTFE) mesh. Surg Endosc 14:1189PubMedGoogle Scholar
  27. 27.
    Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78:903–906PubMedCrossRefGoogle Scholar
  28. 28.
    Biondi A, Tropea A, Monaco G, Musmeci N, Zanghi G, Basile F (2010) Complications in the laparoscopic treatment of primary, secondary hernias of the abdominal wall. Ann Ital Chir 81:193–198PubMedGoogle Scholar
  29. 29.
    Eriksen JR, Gögenur I, Rosenberg J (2007) Choice of mesh for laparoscopic ventral hernia repair. Hernia 11:481–492PubMedCrossRefGoogle Scholar
  30. 30.
    Ferrari GC, Miranda A, Sansonna F, Magistro C, Di Lernia S, Maggioni D, Franzetti M, Costanzi A, Pugliese R (2009) Laparoscopic repair of incisional hernias located on the abdominal borders: a retrospective critical review. Surg Laparosc Endosc Percutan Tech 19:348–352PubMedCrossRefGoogle Scholar
  31. 31.
    Carbonell AM, Kercher KW, Matthews BD, Sing RF, Cobb WS, Heniford BT (2005) The laparoscopic repair of suprapubic ventral hernias. Surg Endosc 19:174–177PubMedCrossRefGoogle Scholar
  32. 32.
    Eid GM, Prince JM, Mattar SG, Hamad G, Ikrammudin S, Schauer PR (2003) Medium-term follow-up confirms the safety, durability of laparoscopicventral hernia repair with PTFE. Surgery 134:599–603PubMedCrossRefGoogle Scholar
  33. 33.
    Uranues S, Salehi B, Bergamaschi R (2008) Adverse events, quality of life, recurrence rates after laparoscopic adhesiolysis, recurrent incisional hernia mesh repair in patients with previous failed repairs. J Am Coll Surg 207:663–669PubMedCrossRefGoogle Scholar
  34. 34.
    Farrakha M (2006) Laparoscopic ventral hernia repair using expanded polytetrafluoroethylene-polyester mesh compound. Surg Endosc 20:820–823PubMedCrossRefGoogle Scholar
  35. 35.
    Chowbey PK, Sharma A, Khullar R, Mann V, Baijal M, Vashistha A (2000) Laparoscopic ventral hernia repair. J Laparoendosc Adv Surg Tech A 10:79–84PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  1. 1.Unit of Innovation in Minimally Invasive SurgeryUniversity Hospital “Virgen del Rocío”SevillaSpain

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