Massey L H, Pathak S, Bhargava A, Smart N J, Daniels I R
Exeter Surgical Health Services Research Unit, Royal Devon and Exeter Hospital, Barrack Road, Exeter, Devon, EX2 5DW, UK.
Bristol Royal Infirmary, Upper Maudlin Street, Bristol, BS2 8HW, UK.
Hernia. 2018 Apr;22(2):273-283. doi: 10.1007/s10029-017-1690-z. Epub 2017 Oct 25.
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.
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.
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.
There is currently insufficient quality evidence to recommend any of the investigated methods, some of which incur significant additional cost.
切口疝修补术后血清肿形成仍是一种常见的并发症。手术引流的使用很广泛，但关于其使用及其他辅助手段的证据有限。我们的目的是对用于降低术后血清肿形成发生率的技术相关文献进行系统综述。
使用包括“切口疝”和“血清肿”等术语对PubMed和Embase数据库进行系统检索。纳入所有关于接受开放性切口疝修补术的成年人且至少有一种旨在减少血清肿形成的干预措施的研究。
在检索到的1093项研究中，9项符合纳入标准。医用滑石粉：一项对74例腹膜前补片置入后应用滑石粉的患者的队列研究发现，血清肿形成率显著降低，从20.8%降至2.7%（p<0.001），但一项纳入21例使用覆盖补片患者的回顾性研究发现，血清肿形成率从9.5%升至76%（p=0.001）。纤维蛋白胶：一项纳入60例患者的比较研究发现血清肿形成率从53%降至10%（p=0.003），而一项对250例患者的回顾性研究未发现差异（11%对4.9%，p=0.07）。负压伤口治疗：四项回顾性研究共纳入358例患者，发现血清肿结局无差异。其他：一项对42例接受吸引引流或“褥式”缝合的患者的随机研究发现血清肿形成无差异。
目前没有足够的高质量证据推荐任何一种所研究的方法，其中一些方法会产生显著的额外费用。
