Electric cauterization of the hernia sac in laparoscopic ventral hernia repair reduces the incidence of postoperative seroma: a propensity score-matched analysis
- 1 Downloads
Laparoscopic intraperitoneal mesh repair has become one of the most commonly performed minimally invasive procedures. Nevertheless, despite improved overall outcome, postoperative seroma formation remains the most frequent complication. Our objective was to investigate the effectiveness of cauterization of the hernia sac in terms of reducing the incidence of postoperative seroma formation.
A retrospective analysis of 94 patients who underwent standard laparoscopic intraperitoneal mesh repair without closure of the central defect (sIPOM) between June 2011 and December 2014 was conducted. In 20 of those cases, electric cauterization of the hernia sac was additionally performed (csIPOM). One-to-one propensity score analysis was conducted to overcome patient selection bias between the two surgical techniques. The case–control group was matched by gender, body mass index (BMI), patient comorbidities, and surface of the hernia defect. Patient demographics, pre- and postoperative pain score (using a ten-point Likert scale), operative data, and complications were collected. At follow-up, postoperative seroma, hernia recurrence, and chronic pain were evaluated.
Patient demographics, hernia size, comorbidities, and BMI were similar between the two groups. The csIPOM patient group had significantly lower rate of seroma formation, compared to the sIPOM control [csIPOM vs. sIPOM 0 vs. 25% (n = 5), p < 0.05]. There was no difference noted regarding postoperative pain between the two techniques. Hernia recurrence rate was found to be higher in the sIPOM group [csIPOM vs. sIPOM 0 vs 12.5% (n = 2), p < 0.05].
The present study confirms our hypothesis that laparoscopic sIPOM combined with electric cauterization of the hernia sac (csIPOM) significantly reduces the rate of postoperative seroma compared to the sIPOM technique in patients with ventral and incisional hernias. Further randomized trials are required to verify our findings.
KeywordsLaparoscopic ventral hernia repair Laparoscopic intraperitoneal onlay mesh Postoperative seroma Hernia sac cauterization
Dr. DP designed the study collected the data, analyzed the data, and wrote the manuscript. Dr. F-JS designed the study and wrote the manuscript.
Compliance with ethical standards
Conflict of interest
Drs. Dimitrios Prassas and Franz-Josef Schumacher declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Human and animal rights
This article does not contain any studies with animals performed by any of the authors.
Informed consent was obtained from all individual participants included in the study.
- 2.Sauerland S, Walgenbach M, Habermalz B, Seiler CM, Miserez M (2011) Laparoscopic versus open techniques for ventral or incisional hernia repair. Cochrane Database Syst Rev 16(3):CD007781Google Scholar
- 4.Mercoli H, Tzedakis S, D’Urso A, Nedelcu M, Memeo R, Meyer N, Vix M, Peretta S, Mutter D (2017) Postoperative complications as an independent risk factor for recurrence after laparoscopic ventral hernia repair: a prospective study of 417 patients with long-term follow-up. Surg Endosc 31(3):1469–1477CrossRefPubMedGoogle Scholar