Department of Surgery, MERAV Medical Center, Bat-Yam, Israel.
Hernia Excellence, Tel-Aviv, Israel.
Hernia. 2019 Dec;23(6):1291-1296. doi: 10.1007/s10029-019-01956-2. Epub 2019 May 4.
Subcutaneous Seroma formation (SF) is commonly seen after abdominal wall Hernia surgeries and reconstructive surgeries due to large dissecting dead space and is associated with increased morbidity. SF is common particularly after big abdominal wall hernia repairs and its treatment can be challenging and long. Current prevention methods are not consistent and the treatment includes repeated aspirations and drains, both are associated with higher risk for infections. The purpose of this article is to present a novel and simple technique of Intraoperative Hypertonic Saline Irrigation (IHSI) to abdominal wall subcutaneous large dead space, which prevent postoperative SF and enables early drain removal due to reduced secretions.
Eight patients undergone the Extended Endoscopic Hernia & Linea Alba Reconstruction Glue surgery (eEHLARglue), for Ventral Hernias (VH) and Rectus Muscles Separation (RMS). An extensive Endoscopic 450cm dissection free surface of the anterior Rectus fascia, is performed prior to Hernia dissection and closing of the RMS. It is followed by onlay mesh placing over the repaired Rectus muscles and the mesh is fused into the muscles by Fibrin Glue. The novel preventive method is based on Intraoperative Irrigation of the vast cavity through the two 10 mm JP closed system drains with 20 cc of NaCl 12% left at site for 10 min.
Our early results with all our patients show seroma prevention, lower secretion rate of 20 cc in 10 h and drain removal within 20-24 h.
IHSI enhance adhesion formation and reduce secretion rate in wide subcutaneous dissection space like in eEHLARglue, 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 simple technique could be used in other potential postoperative SF surgeries. Further larger study with a longer follow up is advised.
腹壁疝和重建手术后，由于大的解剖死腔，皮下血清肿（SF）很常见，且与发病率增加有关。SF 在大的腹壁疝修复后很常见，其治疗可能具有挑战性且耗时较长。目前的预防方法并不一致，治疗包括反复抽吸和引流，两者都与更高的感染风险相关。本文旨在介绍一种新的术中高渗盐水灌洗（IHSI）腹壁皮下大死腔的技术，该技术可预防术后 SF，并由于减少分泌物而使引流管早期移除。
8 例患者接受了扩展内镜疝和白线重建胶手术（eEHLARglue），用于治疗腹疝（VH）和腹直肌分离（RMS）。在疝切开和 RMS 关闭之前，先进行广泛的内镜 450cm 游离前腹直肌筋膜表面。随后，在修复后的腹直肌上放置网片，并通过纤维蛋白胶将网片融合到肌肉中。这种新的预防方法是基于通过两个 10mm JP 闭合系统引流管对大腔进行术中灌洗，每个引流管用 20cc 12%NaCl 留置 10 分钟。
我们所有患者的早期结果均显示预防了血清肿，在 10 小时内的分泌物量为 20cc，引流管在 20-24 小时内移除。
IHSI 增强了在 eEHLARglue 等广泛皮下解剖空间中的黏附形成和减少分泌物的速度，因此可以早期移除引流管并预防 SF。从而降低整体发病率和住院时间，减少多次门诊就诊或额外手术的不便和成本节约。这种简单的技术可以用于其他潜在的术后 SF 手术。建议进行进一步的更大规模研究并进行更长时间的随访。
