Preventing Postoperative Seroma formation in Abdominal wall Hernia by Intraoperative Hypertonic Saline Irrigation, early Report

Abstract

Aims: Seroma formation (SF) is a frequent post-operative complication as in Abdominal Wall Hernias (AWH) and reconstructive surgeries, where extensive dissection take place. It increases overall morbidity and can be challenging to manage. Drains, aspirations and sclerotherapy are established for treating postoperative seromas and increase the risk for infections. No study has yet to describe the use of intraoperative preventive measures for SF. The purpose of this report is to describe a novel method of Intraoperative Hypertonic Saline Irrigation (IHSI) to abdominal wall subcutaneous surgical cavity, which prevent SF and enables a shorter drainage usage due to early drain removal. Methods: This study includes seven patients who undergone the Extended Endoscopic Hernia & Linea Alba Reconstruction Glue surgery (eEHLARglue), for AWH and Rectus Muscles Separation (RMS). An extensive Endoscopic dissection of the anterior Rectus fascia is performed prior to dissecting and reducing into the abdominal cavity any hernia followed by closing of the RMS. A mesh is placed over the repaired RMS and is fused into the muscles by Fibrin Glue. The novel preventive method is based on Intraoperative Irrigation of the subcutaneous cavity through two 7 mm closed system drains with 20 cc of NaCl 10% which are left in place for 10 min. Results: Our early results with all our 7 patients over three months of follow up, show seroma prevention, lower drain secretion rate of 20 cc in 10 h and drains removal within 20-24 h. Conclusions: IHSI enhances fusion adhesions and reduce secretion rate and therefore enables early drain removal and prevent SF. As a result, reducing overall morbidity and hospitalization period, decreasing inconveniency and cost saving of multiple outpatient visits or additional surgery. This novel technique could be used in addition to AWH in many others potential postoperative SF surgeries. Further research is advised.