Postoperative Seroma Formation
Seromas can develop after both open and laparoscopic hernia repairs. It is required to describe this common complication to the patient during the informed consent process. A simple and often effective tool to decrease/minimize seroma formation is the placement of abdominal binders to compress the space and try to prevent fluid from collecting between the layers of the repair. If small and not bothersome, a seroma can be managed conservatively. It is expected in these cases that, over time, the body will resorb the fluid. Larger seromas need drainage if symptomatic. Repeated drainage procedures can be utilized to treat seromas; however, repeated aspirations run the risk of introducing the skin bacterial flora into that fluid and can cause infection of the prosthetic mesh material. These permanent meshes–depending on their porous composition–vary in their resistance to infection. Drains can be placed into seroma cavities, but also run the risk of infection. Sclerosing agents–TPA, talc—or surgical glues can also be instilled (whether by general surgery or interventional radiology (IR)) into the seroma cavity to try to obliterate the space, with varying degrees of success.
Regardless, prompt diagnosis, knowledge of these adjunct therapies, and timely implementation are necessary to treat seromas, and prevent their recurrence. Chronic seromas can require operative debridement to obliterate the loculations (septations within the seroma cavity), and open debridement can be combined with drain placement and/or the use of glues, etc., to try to collapse the space. Seromas often are frustrating for the patient and the treating surgeon alike.