Hayakawa Shunsuke, Hayakawa Tetsushi, Watanabe Kaori, Saito Kenta, Miyai Hirotaka, Sagawa Hiroyuki, Ogawa Ryo, Yamamoto Minoru, Kobayashi Kenji, Tanaka Moritsugu, Takiguchi Shuji
Graduate School of Medical Sciences, Gastroenterological Surgery, Nagoya City University, 1banchi Kawasumi, Mizuho-cho, Mizuho-Ku, Nagoya City, Aichi, 467-8602, Japan.
Department of General Surgery, Kariya Toyota General Hospital, Kariya, Japan.
Hernia. 2025 May 23;29(1):177. doi: 10.1007/s10029-025-03366-z.
This study aimed to develop a classification to precisely describe seroma following transabdominal preperitoneal hernia repair (TAPP) as well as identify risk factors and create a prediction model for seroma development.
Postoperative seroma was classified into grades 0-IV, with grades ≥ II defined as the seroma group (S group: 265 cases), which was compared with the normal course group (N group: 1,279 cases) to determine risk factors using logistic regression analysis. A prediction model was developed based on these independent predictors. Receiver operating characteristic (ROC) curve analysis was conducted to assess the discriminability and calibrability of the model. Additionally, a model to validate the incidence of seroma was used for risk stratification.
This classification revealed grades 0, I, II, III, and IV in 1,194 (70.9%), 85 (5.5%), 236 (15.3%), 12 (0.8%), and 17 (1.1%) patients, respectively. Multivariate analysis revealed risk factors for seroma formation, including age of > 66 years, American Society of Anesthesiologists scores of ≥ 2, surgery for recurrent hernia, size of hernia defect of > 3 cm, and duration of sickness of > 1 year. The prediction model demonstrated the rates of seroma in the low, moderate, and high score groups of 10.5% (103/984), 23.7% (99/417), and 44.1% (63/143), respectively.
A postoperative complication of TAPP was proposed as a severity classification of seroma. A model to predict the seroma was developed based on the identified risk factors, thereby confirming the possibility of preoperative prediction of the seroma.
本研究旨在建立一种分类方法，以精确描述经腹腹膜前疝修补术（TAPP）后血清肿的情况，同时识别风险因素并创建血清肿发生的预测模型。
术后血清肿分为0-IV级，≥II级定义为血清肿组（S组：265例），与正常病程组（N组：1279例）进行比较，采用逻辑回归分析确定风险因素。基于这些独立预测因素建立预测模型。进行受试者工作特征（ROC）曲线分析以评估模型的区分能力和校准能力。此外，使用一个验证血清肿发生率的模型进行风险分层。
该分类显示，1194例（70.9%）、85例（5.5%）、236例（15.3%）、12例（0.8%）和17例（1.1%）患者分别为0级、I级、II级、III级和IV级。多因素分析揭示了血清肿形成的风险因素，包括年龄>66岁、美国麻醉医师协会评分≥2、复发性疝手术、疝缺损大小>3 cm以及病程>1年。预测模型显示，低、中、高分值组的血清肿发生率分别为10.5%（103/984）、23.7%（99/417）和44.1%（63/143）。
提出了TAPP术后并发症血清肿的严重程度分类。基于识别出的风险因素建立了血清肿预测模型，从而证实了术前预测血清肿的可能性。
