, Volume 22, Issue 2, pp 273–283 | Cite as

The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review

  • L. H. Massey
  • S. Pathak
  • A. Bhargava
  • N. J. Smart
  • I. R. Daniels



Seroma formation remains a common complication after an incisional hernia repair. The use of surgical drains is widespread, but evidence for their use and other adjuncts is limited. Our aim was to perform a systematic review of the literature on techniques used to reduce the incidence of post-operative seroma formation.


A systematic search of PubMed and Embase databases was conducted using terms including “incisional hernia” and “seroma”. All studies on adults undergoing open incisional hernia repair with at least one intervention designed to reduce seroma formation were included.


Of the 1093 studies identified, 9 met the inclusion criteria. Medical talc: one cohort study of 74 patients undergoing talc application following pre-peritoneal mesh placement found a significantly decreased rate of seroma formation of 20.8 versus 2.7% (p < 0.001), but a retrospective study including 21 patients with onlay mesh found an increased rate of 76% seroma formation from 9.5% (p = 0.001). Fibrin glue: one comparative study including 60 patients found a reduction in seroma formation from 53 to 10% (p = 0.003), whereas a retrospective study of 250 patients found no difference (11 vs. 4.9% p = 0.07). Negative pressure wound therapy: four retrospective studies including a total of 358 patients found no difference in seroma outcome. Others: one randomised study of 42 patients undergoing either suction drainage or “quilting” sutures found no difference in seroma formation.


There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.


Abdominal wall Hernia Mesh Seroma Incisional Negative pressure wound therapy 


Compliance with ethical standards

Conflict of interest

LM declares no conflict of interest. SP declares no conflict of interest. AB declares conflict of interest not directly related to the submitted work (speaker’s fees from Medtronic). NS declares conflict of interest not directly related to the submitted work (speaker’s fees from Medtronic). ID declares conflict of interest not directly related to the submitted work (grants, personal fees and non-financial support from Medtronic).

Ethical approval

This study design conformed to ethical standards.

Human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

There were no individual participants included in this study.


  1. 1.
    Diener MK, Voss S, Jensen K, Buchler MW, Seiler CM (2010) Elective midline laparotomy closure: the INLINE systematic review and meta-analysis. Ann Surg 251(5):843–856CrossRefPubMedGoogle Scholar
  2. 2.
    den Hartog D, Dur AH, Tuinebreijer WE, Kreis RW (2008) Open surgical procedures for incisional hernias. Cochrane Database Syst Rev 3:CD006438. doi: 10.1002/14651858.CD006438.pub2 Google Scholar
  3. 3.
    Deerenberg EB, Timmermans L, Hogerzeil DP, Slieker JC, Eilers PH, Jeekel J, Lange JF (2015) A systematic review of the surgical treatment of large incisional hernia. Hernia 19(1):89–101CrossRefPubMedGoogle Scholar
  4. 4.
    Klinge U, Conze J, Krones CJ, Schumpelick V (2005) Incisional hernia: open techniques. World J Surg 29(8):1066–1072CrossRefPubMedGoogle Scholar
  5. 5.
    Westphalen AP, Araujo AC, Zacharias P, Rodrigues ES, Fracaro GB, Lopes Filho GD (2015) Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial. Acta Cir Bras 30(12):844–851CrossRefPubMedGoogle Scholar
  6. 6.
    Kohler G, Koch OO, Antoniou SA, Lechner M, Mayer F, Emmanuel K (2014) Prevention of sub-cutaneous seroma formation in open ventral hernia repair using a new low-thrombin fibrin sealant. World J Surg 38(11):2797–2803CrossRefPubMedGoogle Scholar
  7. 7.
    de Vries M, Hoekstra HJ, Hoekstra-Weebers JE (2009) Quality of life after axillary or groin sentinel lymph node biopsy, with or without completion lymph node dissection, in patients with cutaneous melanoma. Ann Surg Oncol 16(10):2840–2847CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Bercial ME, Sabino Neto M, Calil JA, Rossetto LA, Ferreira LM (2012) Suction drains, quilting sutures, and fibrin sealant in the prevention of seroma formation in abdominoplasty: which is the best strategy? Aesthetic Plast Surg 36(2):370–373CrossRefPubMedGoogle Scholar
  9. 9.
    Schachtrupp A, Klinge U, Junge K, Rosch R, Bhardwaj RS, Schumpelick V (2003) Individual inflammatory response of human blood monocytes to mesh biomaterials. Br J Surg 90(1):114–120CrossRefPubMedGoogle Scholar
  10. 10.
    Kaafarani HM, Hur K, Hirter A, Kim LT, Thomas A, Berger DH, Reda D, Itani KM (2009) Seroma in ventral incisional herniorrhaphy: incidence, predictors and outcome. Am J Surg 198(5):639–644CrossRefPubMedGoogle Scholar
  11. 11.
    Pring CM, Tran V, O’Rourke N, Martin IJ (2008) Laparoscopic versus open ventral hernia repair: a randomized controlled trial. ANZ J Surg 78(10):903–906CrossRefPubMedGoogle Scholar
  12. 12.
    Bedi AP, Bhatti T, Amin A, Zuberi J (2007) Laparoscopic incisional, ventral hernia repair. J Minim Access Surg 3:83–90CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Susamallian S, Gewurtz G, Ezri T, Charuzi I (2001) Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia 5:139–141CrossRefGoogle Scholar
  14. 14.
    Morales-Conde S (2012) A new classification for seroma after laparoscopic ventral hernia repair. Hernia 16(3):261–267CrossRefPubMedGoogle Scholar
  15. 15.
    PROSPERO international register of systematic reviews. York University.
  16. 16.
    Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med 6(7):e1000097CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Shaw P, Agarwal R (2004) Pleurodesis for malignant pleural effusions. Cochrane Data-base Syst Rev 1(1):CD002916. doi: 10.1002/14651858.CD002916.pub2 Google Scholar
  18. 18.
    Klima DA, Belyansky I, Tsirline VB, Lincourt AE, Lipford EH, Getz SB, Heniford BT (2012) Application of subcutaneous talc after axillary dissection in a porcine model safely reduces drain duration and prevents seromas. J Am Coll Surg 214(3):338–347CrossRefPubMedGoogle Scholar
  19. 19.
    Dunn CJ, Goa KL (1999) Fibrin sealant. Drugs 58(5):863–886CrossRefPubMedGoogle Scholar
  20. 20.
    Slim K, Nini E, Forestier D, Kwiatkowski F, Panis Y, Chipponi J (2003) Methodological index for non-randomized studies (minors): development and validation of a new instrument. ANZ J Surg 73(9):712–716CrossRefPubMedGoogle Scholar
  21. 21.
    Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA (2011) The Cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ 343:d5928CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Azoury SC, Rodriguez-Unda N, Soares KC, Hicks CW, Baltodano PA, Poruk KE, Hu QL, Cooney CM, Cornell P, Burce K, Eckhauser FE (2015) The effect of TISSEEL fibrin sealant on seroma formation following complex abdominal wall hernia repair: a single institutional review and derived cost analysis. Hernia 19(6):935–942CrossRefPubMedGoogle Scholar
  23. 23.
    Conde-Green A, Chung TL, Holton LH, Hui-Chou HG, Zhu Y, Wang H, Zahiri H, Singh DP (2013) Incisional negative-pressure wound therapy versus conventional dressings following abdominal wall reconstruction: a comparative study. Ann Plast Surg 71(4):394–397CrossRefPubMedGoogle Scholar
  24. 24.
    Gassman A, Mehta A, Bucholdz E, Abthani A, Guerra O, Maclin MM, Esposito T, Thomas C (2015) Positive outcomes with negative pressure therapy over primarily closed large abdominal wall reconstruction reduces surgical site infection rates. Hernia 19(2):273–278CrossRefPubMedGoogle Scholar
  25. 25.
    Klima DA, Brintzenhoff RA, Tsirline VB, Belyansky I, Lincourt AE, Getz S, Heniford BT (2011) Application of subcutaneous talc in hernia repair and wide subcutaneous dissection dramatically reduces seroma formation and postoperative wound complications. Am Surg 77(7):888–894PubMedGoogle Scholar
  26. 26.
    Olona C, Duque E, Caro A, Jimenez A, Moreno F, Coronas JM, Vicente V (2014) Negative-pressure therapy in the postoperative treatment of incisional hernioplasty wounds: a pilot study. Adv Skin Wound Care 27(2):77–80CrossRefPubMedGoogle Scholar
  27. 27.
    Parameswaran R, Hornby ST, Kingsnorth AN (2013) Medical talc increases the incidence of seroma formation following onlay repair of major abdominal wall hernias. Hernia 17(4):459–463CrossRefPubMedGoogle Scholar
  28. 28.
    Soares KC, Baltodano PA, Hicks CW, Cooney CM, Olorundare IO, Cornell P, Burce K, Eckhauser FE (2015) Novel wound management system reduction of surgical site morbidity after ventral hernia repairs: a critical analysis. Am J Surg 209(2):324–332CrossRefPubMedGoogle Scholar
  29. 29.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Muysoms FE, Deerenberg EB, Peeters E, Agresta F, Berrevoet F, Campanelli G, Ceelen W, Champault GG, Corcione F, Cuccurullo D, DeBeaux AC, Dietz UA, Fitzgibbons RJ Jr, Gillion JF, Hilgers RD, Jeekel J, Kyle-Leinhase I, Kockerling F, Mandala V, Montgomery A, Morales-Conde S, Simmermacher RK, Schumpelick V, Smietanski M, Walgenbach M, Miserez M (2013) Recommendations for reporting outcome results in abdominal wall repair: results of a Consensus meeting in Palermo, Italy, 28-30 June 2012. Hernia 17(4):423–433CrossRefPubMedGoogle Scholar
  31. 31.
    Fang Z, Ren F, Zhou J, Tian J (2015) Biologic mesh versus synthetic mesh in open inguinal hernia repair: system review and meta-analysis. ANZ J Surg 85(12):910–916CrossRefPubMedGoogle Scholar
  32. 32.
    Satterwhite TS, Miri S, Chung C, Spain D, Lorenz HP, Lee GK (2012) Outcomes of complex abdominal herniorrhaphy: experience with 106 cases. Ann Plast Surg 68(4):382–388CrossRefPubMedGoogle Scholar
  33. 33.
    Petro CC, Novitsky YW (2016) Classification of hernias. In: Novitsky YW (ed) Hernia surgery. Springer, Cham, pp 15–21. doi: 10.1007/978-3-319-27470-6_2 Google Scholar
  34. 34.
    Muysoms F (2017) Evaluating outcomes and evidence in hernia repair. In: Cobb WS, Adrales GL, Hope WW (eds) Textbook of hernia. Springer, Cham, pp 15–21CrossRefGoogle Scholar
  35. 35.
    Gurusamy KS, Allen VB (2013) Wound drains after incisional hernia repair. Cochrane Database Syst Rev 12:CD005570. doi: 10.1002/14651858.CD005570.pub4 Google Scholar
  36. 36.
    Klink CD, Binnebosel M, Lucas AH, Schachtrupp A, Klinge U, Schumpelick V, Junge K (2010) Do drainage liquid characteristics serve as predictors for seroma formation after incisional hernia repair? Hernia 14(2):175–179CrossRefPubMedGoogle Scholar
  37. 37.
    Sforza M, Husein R, Andjelkov K, Rozental-Fernandes PC, Zaccheddu R, Jovanovic M (2015) Use of quilting sutures during abdominoplasty to prevent seroma formation: are they really effective? Aesthet Surg J 35(5):574–580CrossRefPubMedGoogle Scholar
  38. 38.
    Ouldamer L, Bonastre J, Brunet-Houdard S, Body G, Giraudeau B, Caille A (2016) Dead space closure with quilting suture versus conventional closure with drainage for the prevention of seroma after mastectomy for breast cancer (QUISERMAS): protocol for a multicentre randomised controlled trial. BMJ Open 6(4):e009903CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Choi MS, Kim HK, Kim WS, Bae TH, Kim MK (2012) A comparison of triamcinolone acetonide and fibrin glue for seroma prevention in a rat mastectomy model. Ann Plast Surg 69(2):209–212CrossRefPubMedGoogle Scholar
  40. 40.
    Taghizadeh R, Shoaib T, Hart AM, Weiler-Mithoff EM (2008) Triamcinolone reduces seroma re-accumulation in the extended latissimus dorsi donor site. J Plast Reconstr Aesthet Surg 61(6):636–642CrossRefPubMedGoogle Scholar
  41. 41.
    Qvamme G, Axelsson CK, Lanng C, Mortensen M, Wegeberg B, Okholm M, Arpi MR, Szecsi PB (2015) Randomized clinical trial of prevention of seroma formation after mastectomy by local methylprednisolone injection. Br J Surg 102(10):1195–1203CrossRefPubMedGoogle Scholar
  42. 42.
    Ali-Khan AS, Orlando A, Kenealy J (2009) Erythromycin sclerotherapy in the management of seroma. J Plast Reconstr Aesthet Surg 62(3):e55–e58CrossRefPubMedGoogle Scholar
  43. 43.
    Skillman JM, Venus MR, Nightingale P, Titley OG, Park A (2014) Ligating perforators in abdominoplasty reduces the risk of seroma. Aesthetic Plast Surg 38(2):446–450CrossRefPubMedGoogle Scholar
  44. 44.
    Bouvier A, Rat P, Drissi-Chbihi F, Bonnetain F, Lacaine F, Mariette C, Ortega-Deballon P (2014) Abdominal binders after laparotomy: review of the literature and French survey of policies. Hernia 18(4):501–506CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag France SAS 2017

Authors and Affiliations

  • L. H. Massey
    • 1
  • S. Pathak
    • 2
  • A. Bhargava
    • 3
  • N. J. Smart
    • 1
  • I. R. Daniels
    • 1
  1. 1.Exeter Surgical Health Services Research UnitRoyal Devon and Exeter HospitalExeterUK
  2. 2.Bristol Royal InfirmaryBristolUK
  3. 3.Institute of Health SciencesQueen Mary University of LondonLondonUK

Personalised recommendations