Abstract
Purpose
A persistent seroma located posterior to a mesh (PPS) remains a little known complication after laparoscopic ventral hernia repair (LVHR). The aim of this large case series was to analyse the prevalence and clinical course as well as identify related factors and independent predictors of PPS.
Methods
All 1288 adult patients who underwent a LVHR with an expanded polytetrafluoroethylene mesh (ePTFE) between January 2003 and July 2014 were reviewed. Those who underwent an abdominal computed tomography (CT) scan more than 3 months afterwards (n = 166) were included and their scans were analysed. The primary outcome measure was the prevalence of a PPS and its characteristics. The secondary outcome measures were identification of significantly related factors and independent predictors of PPS.
Results
A PPS was observed in 14 of 166 analysed CT scans (8.4%). Eleven patients were symptomatic; conservative treatment (wait-and-see policy) was successful in eight. Three underwent relaparoscopy with removal of a thick neoperitoneum. Several instances of tack and/or mesh detachment were identified on CT scans and during relaparoscopy. Independent predictors were: > 3 trocars (RR 5.0, 95% CI 1.6–15.8) and use of a mesh larger than > 300 cm2 (RR 9.9, 95% CI 1.9–51.2).
Conclusions
A PPS is a relatively common complication after LVHR with an ePTFE mesh of usually larger hernias. A “wait-and-see” approach seems justified in most cases. Some require laparoscopic excision of the thick neoperitoneum. A PPS can cause tack and mesh detachment but the clinical consequences are unclear. Recurrences have not been observed in this series.
Similar content being viewed by others
References
Heniford BT, Park A, Ramshaw BJ, Voeller G (2003) Laparoscopic repair of ventral hernias nine years’ experience with 850 consecutive hernias. Trans. Meet Am Surg Assoc 121:85–94. https://doi.org/10.1097/01.sla.0000086662.49499.ab
Tsereteli Z, Ramshaw B, Ramaswamy A (2008) Chronic posterior seroma with neoperitoneum following laparoscopic ventral hernia repair: treatment algorithm. Hernia 12:363–366. https://doi.org/10.1007/s10029-008-0350-8
Scott PD, Harold KL, Craft RO, Roberts CC (2008) Radiology case reports postoperative seroma deep to mesh after laparoscopic ventral hernia repair: computed tomography appearance and implications for treatment. Radiol Case Rep 3:1–4. https://doi.org/10.2484/rcr.v3i1.128
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 19:943–947. https://doi.org/10.1007/s10029-015-1352-y
Wassenaar E, Schoenmaeckers E, Raymakers J et al (2010) Mesh-fixation method and pain and quality of life after laparoscopic ventral or incisional hernia repair: a randomized trial of three fixation techniques. Surg Endosc 24:1296–1302. https://doi.org/10.1007/s00464-009-0763-1
Rakic S, Leblanc KA (2013) The radiologic appearance of prosthetic materials used in hernia repair and a recommended classification. AJR Am J Roentgenol. https://doi.org/10.2214/ajr.13.10703
O’Brien JA, Ignotz R, Montilla R et al (2011) Long-term histologic and mechanical results of a Permacol™ abdominal wall explant. Hernia 15:211–215. https://doi.org/10.1007/s10029-010-0628-5
Chelala E, Baraké H, Estievenart J et al (2016) Long-term outcomes of 1326 laparoscopic incisional and ventral hernia repair with the routine suturing concept: a single institution experience. Hernia 20:101–110. https://doi.org/10.1007/s10029-015-1397-y
Klinge U, Klosterhalfen B, Müller M, Schumpelick V (1999) Foreign body reaction to meshes used for the repair of abdominal wall hernias. Eur J Surg 165:665–673. https://doi.org/10.1080/11024159950189726
Wassenaar EB, Schoenmaeckers EJP, Raymakers JTFJ, Rakic S (2010) Subsequent abdominal surgery after laparoscopic ventral and incisional hernia repair with an expanded polytetrafluoroethylene mesh: a single institution experience with 72 reoperations. Hernia 14:137–142. https://doi.org/10.1007/s10029-009-0568-0
Schoenmaeckers EJP, van der Valk SBA, van den Hout HW et al (2009) Computed tomographic measurements of mesh shrinkage after laparoscopic ventral incisional hernia repair with an expanded polytetrafluoroethylene mesh. Surg Endosc 23:1620–1623. https://doi.org/10.1007/s00464-009-0500-9
Beldi G, Wagner M, Bruegger LE et al (2011) Mesh shrinkage and pain in laparoscopic ventral hernia repair: a randomized clinical trial comparing suture versus tack mesh fixation. Surg Endosc Other Interv Tech 25:749–755. https://doi.org/10.1007/s00464-010-1246-0
Carter PR, LeBlanc KA, Hausmann MG et al (2012) Does expanded polytetrafluoroethylene mesh really shrink after laparoscopic ventral hernia repair? Hernia 16:321–325. https://doi.org/10.1007/s10029-011-0898-6
Rogmark P, Ekberg O, Montgomery A (2017) Long-term retromuscular and intraperitoneal mesh size changes within a randomized controlled trial on incisional hernia repair, including a review of the literature. Hernia 21:687–696. https://doi.org/10.1007/s10029-017-1624-9
Funding
No financial support has been accepted for this research and/or publication.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
VS declares no conflict of interest. RH declares no conflict of interest. JR declares no conflict of interest. SR declares no conflict of interest.
Ethical approval
Approval from the institutional review board was not required for this study.
Human and animal rights
This article does not contain any studies with human participants or animals performed by any of the authors.
Informed consent
For this type of study formal consent is not required.
Rights and permissions
About this article
Cite this article
Stirler, V.M.A., de Haas, R.J., Raymakers, J.T.F.J. et al. Persistent posterior seroma after laparoscopic repair of ventral abdominal wall hernias with expanded polytetrafluoroethylene mesh: prevalence, independent predictors and detached tacks. Hernia 22, 285–291 (2018). https://doi.org/10.1007/s10029-017-1722-8
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10029-017-1722-8