Morales-Conde Salvador, Gómez-Menchero Julio, Alarcón Isaias, Balla Andrea
Unit of Innovation in Minimally Invasive Surgery, Department of General and Digestive Surgery, University Hospital "Virgen del Rocio," University of Sevilla, Spain.
Unit of General and Digestive Surgery, Hospital Quirónsalud Sagrado Corazón, Sevilla, Spain.
J Laparoendosc Adv Surg Tech A. 2020 Mar;30(3):241-245. doi: 10.1089/lap.2019.0646. Epub 2019 Nov 19.
Retroprosthetic seroma (RS) is defined as a fluid collection located between the abdominal viscera and the intraperitoneal mesh implanted during surgery. Aim of this study is to report the incidence and clinical impact of RS based on the type of mesh implanted during laparoscopic ventral hernia repair (LVHR). Patients who underwent LVHR were allocated in group A if expanded polytetrafluoroethylene (ePTFE) mesh was used during surgery and in group B if other types of mesh were used. Patients were evaluated on postoperative day (POD) 1 and 7 with physical examination and 1 month after surgery by physical examination and with an abdominal computed tomography scan, respectively. Sixty patients were included. Of these 41 patients (68.3%) were included in group A and 19 patients (31.7%) in group B. Signs of RS were not observed in any patient on POD 7. One month after surgery, RS was observed in 13 patients (21.6%). One patient (7.7%) with RS experienced great discomfort and mesh detachment, and underwent a second surgical treatment. All RSs were observed in group A, and the difference with group B was statistically significant ( = .005). The use of ePTFE mesh is related to the development of RS. The treatment of choice without clinical symptoms should be conservative. Randomized control trial and prospective studies with a larger sample size and control group are required to confirm these data, although this study shows a high evidence of the relation of RS and the type of mesh.
假体后血清肿（RS）被定义为手术期间植入的腹腔内脏器与腹膜内补片之间的液体积聚。本研究的目的是基于腹腔镜腹疝修补术（LVHR）期间植入的补片类型报告RS的发生率及临床影响。接受LVHR的患者，如果手术期间使用了膨体聚四氟乙烯（ePTFE）补片则被分配到A组，如果使用了其他类型的补片则被分配到B组。分别在术后第1天和第7天通过体格检查对患者进行评估，并在术后1个月通过体格检查和腹部计算机断层扫描进行评估。纳入了60例患者。其中，41例患者（68.3%）被纳入A组，19例患者（31.7%）被纳入B组。在术后第7天，未在任何患者中观察到RS的体征。术后1个月，在13例患者（21.6%）中观察到RS。1例RS患者（7.7%）出现极大不适和补片移位，并接受了二次手术治疗。所有RS均在A组中观察到，与B组的差异具有统计学意义（=0.005）。ePTFE补片的使用与RS的发生有关。对于没有临床症状的患者，首选的治疗方法应该是保守治疗。尽管本研究显示了RS与补片类型之间关系的高度证据，但仍需要进行随机对照试验以及更大样本量和对照组的前瞻性研究来证实这些数据。
