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

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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

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Author information

Authors and Affiliations

  1. Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK

    L. H. Massey, N. J. Smart & I. R. Daniels

  2. Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK

    S. Pathak

  3. Institute of Health Sciences, Queen Mary University of London, Mile End Road, London, E1 4NS, UK

    A. Bhargava

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  1. L. H. Massey
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Correspondence to L. H. Massey.

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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).

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This study design conformed to ethical standards.

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

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There were no individual participants included in this study.

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Massey, L.H., Pathak, S., Bhargava, A. et al. The use of adjuncts to reduce seroma in open incisional hernia repair: a systematic review. Hernia 22, 273–283 (2018). https://doi.org/10.1007/s10029-017-1690-z

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  • DOI: https://doi.org/10.1007/s10029-017-1690-z

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