Unit of Innovation and Minimally Invasive Surgery, University Hospital Virgen del Rocío, Betis-65, 1, 41010 Seville, Spain.
Surg Endosc. 2013 Sep;27(9):3214-9. doi: 10.1007/s00464-013-2894-7. Epub 2013 Mar 14.
Seroma after laparoscopic ventral hernia repair (LVHR) has been related to certain complications of the technique, such as recurrences and postoperative pain. The aim of this study was to assess whether percutaneous application of fibrin sealant in the hernia sac after LVHR reduces the incidence and volume of the postoperative seroma, and to analyze whether the percentage of patients achieving complete normalization of the abdominal wall increases.
Prospective and comparative study. Patients were distributed into 2 control-case groups. Group 1 comprised patients submitted to LVHR using the double crown technique and a compressing bandage as the only method for prevent seroma. Group 2 comprised patients admitted to LVHR using the same technique together with percutaneous injection of fibrin sealant in the sac, and later applying the same bandage. Patients were examined clinically and radiologically at 7 days, 1 month, and 3 months after surgery.
Twenty-five patients were included in each group. There were significant differences in the incidence of seroma by the day 7 after surgery (92% in group 1 vs. 64 % in group 2, p = 0.017) and by 1 month (72% in group 1 vs. 28% in group 2, p = 0.002). The difference was also significant regarding the achievement of normalization of the abdominal wall by day 7 (24% in group 1 vs. 52% in group 2, p = 0.041) and by month 1 (64% in group 1 vs. 88% in group 2, p = 0.047) after operation. Volume of seroma was larger among patients of group 1 after the week (p = 0.002) and 1 month after operation (p = 0.001).
Fibrin sealant application after LVHR reduces the incidence and volume of the seroma 7 days and 1 month after surgery. The treated patients obtain a larger normalization of the abdominal wall 1 week and 1 month after the operation.
腹腔镜腹疝修补术（LVHR）后的血清肿与该技术的某些并发症有关，如复发和术后疼痛。本研究旨在评估 LVHR 后在疝囊内经皮应用纤维蛋白密封剂是否能降低术后血清肿的发生率和体积，并分析是否能增加腹壁完全正常化的患者比例。
前瞻性比较研究。患者分为 2 个对照组。第 1 组患者采用双冠技术行 LVHR，仅使用加压绷带预防血清肿。第 2 组患者采用相同技术行 LVHR，同时向疝囊内注射纤维蛋白密封剂，然后再使用相同的绷带。术后 7 天、1 个月和 3 个月对患者进行临床和影像学检查。
每组纳入 25 例患者。术后第 7 天血清肿发生率有显著差异（第 1 组 92%，第 2 组 64%，p = 0.017），术后第 1 个月也有显著差异（第 1 组 72%，第 2 组 28%，p = 0.002）。术后第 7 天腹壁正常化的比例也有显著差异（第 1 组 24%，第 2 组 52%，p = 0.041），术后第 1 个月也有显著差异（第 1 组 64%，第 2 组 88%，p = 0.047）。术后第 1 周和第 1 个月，第 1 组患者的血清肿体积更大（p = 0.002 和 p = 0.001）。
LVHR 后应用纤维蛋白密封剂可降低术后 7 天和 1 个月血清肿的发生率和体积。治疗组患者术后第 1 周和第 1 个月腹壁的正常化程度更大。
