Electric cauterization of the hernia sac in laparoscopic ventral hernia repair reduces the incidence of postoperative seroma: a propensity score-matched analysis

Abstract

Background: Laparoscopic intraperitoneal mesh repair has become one of the most commonly performed minimally invasive procedures. Nevertheless, despite improved overall outcome, postoperative seroma formation remains the most frequent complication. Our objective was to investigate the effectiveness of cauterization of the hernia sac in terms of reducing the incidence of postoperative seroma formation.

Methods: A retrospective analysis of 94 patients who underwent standard laparoscopic intraperitoneal mesh repair without closure of the central defect (sIPOM) between June 2011 and December 2014 was conducted. In 20 of those cases, electric cauterization of the hernia sac was additionally performed (csIPOM). One-to-one propensity score analysis was conducted to overcome patient selection bias between the two surgical techniques. The case-control group was matched by gender, body mass index (BMI), patient comorbidities, and surface of the hernia defect. Patient demographics, pre- and postoperative pain score (using a ten-point Likert scale), operative data, and complications were collected. At follow-up, postoperative seroma, hernia recurrence, and chronic pain were evaluated.

Results: Patient demographics, hernia size, comorbidities, and BMI were similar between the two groups. The csIPOM patient group had significantly lower rate of seroma formation, compared to the sIPOM control [csIPOM vs. sIPOM 0 vs. 25% (n = 5), p < 0.05]. There was no difference noted regarding postoperative pain between the two techniques. Hernia recurrence rate was found to be higher in the sIPOM group [csIPOM vs. sIPOM 0 vs 12.5% (n = 2), p < 0.05].

Conclusion: The present study confirms our hypothesis that laparoscopic sIPOM combined with electric cauterization of the hernia sac (csIPOM) significantly reduces the rate of postoperative seroma compared to the sIPOM technique in patients with ventral and incisional hernias. Further randomized trials are required to verify our findings.

Keywords: Hernia sac cauterization; Laparoscopic intraperitoneal onlay mesh; Laparoscopic ventral hernia repair; Postoperative seroma.