透壁缝合法处理直疝假性疝囊预防术后血清肿应用研究

目的探讨在腹腔镜腹股沟疝修补术中使用透壁缝合法处理腹股沟直疝假性疝囊预防术后血清肿的效果。 方法广州市番禺区何贤纪念医院肝胆疝外科自2017年1月1日至2018年6月30日手术治疗的74例直疝患者，其中Ⅰ型疝12例、Ⅱ型37例、Ⅲ型25例，62例Ⅱ型及Ⅲ型患者术中行透壁缝合法处理直疝假性疝囊。 结果74例患者均在腹腔镜下顺利完成腹股沟直疝无张力修补术。Ⅰ型疝手术时间为（38.42±2.81）min，出血量为（4.42±2.31）ml，术后1 d视觉模拟评分（VAS）（2.83±1.19）分，7 d VAS（1.00±0.85）分；Ⅱ型手术时间为（44.49±3.25）min，出血量为（7.00±1.75）ml，术后1 d VAS（2.84±1.21）分，7 d VAS（1.08±0.83）分；Ⅲ型手术时间为（50.64±3.35）min，出血量为（5.92±2.60）ml，1 d VAS（2.84±1.18）分，7 d VAS（0.92±0.86）分。术后随访期无血清肿发生、无睾丸肿胀疼痛、无性生活障碍、无疝复发及腹股沟区慢性疼痛出现。 结论腹腔镜腹股沟疝修补术中透壁缝合法处理直疝假性疝囊对于预防术后血清肿是一种安全、有效、可靠的技术，不增加术后疝复发率及慢性疼痛，值得临床进一步研究。     

腹腔镜腹股沟直疝修补术中假性疝囊处理的临床研究

目的探讨腹股沟直疝经全腹膜外修补术中个体化手术方式固定假性疝囊的临床疗效。 方法选择2014年1月至2016年1月，湖北医药学院附属太和医院收治106例腹股沟直疝患者的临床资料，由随机数字表法随机分成固定组（53例）与常规组（53例）。术后随访2年，分别观察2组手术时间、术后第1和3天疼痛评分、术后住院时间、住院费用及术后并发症（血清肿、局部异物感、阴囊肿胀、伤口感染、腹股沟区慢性疼痛）发生率、术后2年疝复发率。 结果2组患者的手术时间、术后第1和3天疼痛评分和住院时间及住院费用比较，差异无统计学意义（P>0.05）。固定组血清肿及局部异物牵拉感的发生率较常规组显著减少，差异有统计学意义（P<0.05），而在阴囊肿胀、伤口感染、术后腹股沟区慢性疼痛并发症发生率方面比较，差异无统计学意义（P>0.05）。随访2年，2组均无疝复发。 结论腹腔镜腹股沟直疝修补术中采用固定直疝假性疝囊可有效减少术后血清肿及术区异物牵拉感，是一种安全、经济、有效的固定方法。     

Risk of Seroma with Simultaneous Liposuction and Abdominoplasty and the Role of Progressive Tension Sutures

Background This study aimed to evaluate the true risk of seroma with simultaneous abdominoplasty and liposuction and to assess the role of progressive tension suture in preventing it. Methods A retrospective chart review of 235 consecutive abdominoplasties performed by a single surgeon was conducted. Matarasso classification was used, and 146 patients with type 4 abdominoplasty were selected. These patients were divided into two groups. The 96 patients in group A had no progressive tension sutures. This group was further subdivided into subgroup A1 (43 patients), which had abdominoplasty alone, and subgroup A2 (53 patients), which had abdominoplasty with liposuction. The 50 patients in group B had progressive tension sutures. This group was further subdivided into subgroup B1 (26 patients), which had abdominoplasty alone, and subgroup B2 (24 patients), which had abdominoplasty with liposuction. Results The two groups were similar in terms of body mass index, age, and smoking status. The incidence of seroma formation was 26% (n = 25) in group A, as compared with 4% (n = 2) in group B (p = 0.001). Group B showed 0% seroma formation when abdominoplasty alone was performed, as compared with 7.7% when liposuction was performed at the same time (p = 0.08, no statistical difference). Also, no statistical difference was seen when similar subgroups were compared in group A (p = 0.87). Conclusion The findings of this retrospective study show that the application of progressive tension sutures in abdominoplasty significantly reduces the incidence of seroma, and that simultaneous abdominoplasty with liposuction does not contribute to this complication. Presented at the 6th Croatian Congress of Plastic, Reconstructive, and Aesthetic Surgery with International Participation, Opatija-Rijeka, Croatia, 6–11 October 2006, BOA AS36, page 31, and at the 4th Central European Advance Course Prague Czech Republic, 17–20 May 2006, BOA, page 30. An erratum to this article can be found at     

Laparoscopic Total Extraperitoneal Repair in Femoral Hernia Without Fixation of the Mesh

Background & Objectives:

We report on laparoscopic total extraperitoneal repair without fixation of mesh for femoral hernia in 6 patients.

Methods:

During a 3-year period, laparoscopic total extraperitoneal repair of femoral hernia was performed without mesh fixation in 6 patients. The recurrence rate, pain scores, hospital stay, and other morbidity parameters were noted. Pain scores were 1=no pain, 2=mild pain, 3=moderate pain, 4=severe pain, and 5=intolerable pain.

Results:

All 6 patients were females and had unilateral hernias. Mean age was 33.8±18.6 years, and follow-up ranged from 12 months to 36 months. Four patients were operated on while under spinal anesthesia, and 2 patients were operated on while under general anesthesia. Mean operating time was 29.2±10.7 minutes. The mean pain scores 24 hours and the first week after operation were, respectively, 2.33±0.52 and 1.33±0.52. Mean hospital stay was 1.17±0.41 days, and mean days to resumption of normal activities were 8.5±2.1 days. No patient had urinary retention or seroma formation in the postoperative period. At follow-up, no hernia had recurred.

Conclusions:

Laparoscopic femoral hernia repair without fixing the mesh is safe, feasible, and associated with minimal morbidity and recurrence rates.     

Laparoscopic inguinal total extraperitoneal hernia repair under spinal anesthesia without mesh fixation in 1,220 hernia repairs

Background  The need for general anesthesia and the cost and pain due to metal staples required for fixing the mesh are the major reported disadvantages of laparoscopic total extraperitoneal (TEP) hernia repair. We studied the feasibility and results of TEP done under spinal anesthesia with non-fixation of the mesh (SA-NF). This group was compared to TEP done under general anesthesia with non-fixation of the mesh (GA-NF) and repairs done under SA with fixation of the mesh (SA-F). Methods  A retrospective analysis was carried out in 675 patients (1,289 hernias) in whom TEP was performed. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days to resume normal activities, seroma formation, and urinary retention rates were noted. Results  A total of 1,289 TEP repairs (675 patients) were analyzed, with 636 patients (1,220 hernias) in the SA-NF group, 16 patients (27 hernias) in the GA-NF group, and 23 patients (42 hernias) in the SA-F group. Follow up ranged from 13 to 45 months. The recurrence rates, conversion rates, and complications were similar in all three groups. The mean hospital stay, days to resume normal activities, and pain scores were significantly higher in the mesh fixation (SA-F) group. Conclusions  TEP, done under SA and without fixation of the mesh, is safe, feasible, and associated with low recurrence rates. Since this procedure does not have the disadvantages usually attributed to TEP, it can be possibly recommended as a first-line procedure, even for unilateral inguinal hernias. Further studies are needed to substantiate this.     

Laparoscopic total extraperitoneal inguinal hernia repair with nonfixation of the mesh for 1,692 hernias

Background  This study aimed to examine the recurrence rate and postoperative pain in total extraperitoneal repair (TEP) performed without fixation of the mesh and to compare the rates with those for repairs using fixation of mesh. Methods  A retrospective analysis was conducted over a 3-year period for 929 patients (1,753 hernias) who had undergone TEP. The recurrence rate, pain scores at 24 h and 1 week, hospital stay, days until resumption of normal activities, seroma formation, and urinary retention rates were noted. Results  Of the 929 patients (1,753 hernias), the mesh was fixed (Fx) for 33 (61 hernias) and not fixed (NFx) for 896 (1,692 hernias). The follow-up period ranged from 6 to 40 months (mean, 17 months). The two groups did not differ significantly in terms of mean operating time, proportion of patients who had minimal or no pain (score, 1 or 2) 24 h after surgery, or proportion of patients who were totally pain free (score = 1) 1 week postoperatively. The proportions of patients reporting pain at the end of 1 month, the incidence of seroma formation and urinary retention, the hospital stay, and the days until resumption of normal activities were significantly greater in the Fx group than in the NFx group (p < 0.0001). Two patients (0.22%) in the NFx group had recurrence and one patient in the Fx group underwent conversion to open hernia repair. Conclusions  This study found TEP without mesh fixation to be safe and feasible with no increase in recurrence rates. The TEP procedure is associated with significantly less pain at 4 weeks, lower incidence of urinary retention and seroma formation, shorter hospital stay, and early resumption of normal activities.     

Composition of Postabdominoplasty Seroma

BACKGROUND: This study aimed to analyze the composition of postabdominoplasty seroma fluid at different intervals, compare it with blood and lymph, and determine whether it meets the criteria for being considered an exudate. METHODS: The study enrolled 18 female patients with postabdominoplasty seroma diagnosed by clinical and ultrasound evaluation. All the patients had a Matarasso type 4 anterior abdominal wall deformity. None of the patients were overweight, and none had comorbidities. They all underwent a classical abdominoplasty procedure. Fluid samples were taken from the drains between postoperative days 5 and 7, and from needle aspiration between postoperative days 15 and 20. The fluids were assayed in the clinical laboratory at the University of Chile Clinical Hospital for chemical and cellular composition. Blood, lymph, and seroma values were compared by independent group analysis using a Tukey multiple comparison test with an alpha error of 0.05. RESULTS: The total protein, lactate dehydrogenase (LDH), and cholesterol levels for the early and late seroma fluids were lower than in the blood, but higher than in the lymph. The total protein seroma-to-plasma ratio was approximately 0.5; the LDH seroma-to-plasma ratio was approximately 0.6; and the cholesterol seroma-to-plasma ratio was 0.32. The platelet level was very low in the late seroma fluid, showing no statistical differences with the lymph level. The leukocyte level was low in the seroma fluid, with a higher percentage of neutrophils than found in the blood or the lymph. CONCLUSIONS: The serous fluid formed under the flap after an abdominoplasty seems to be an exudate. In the early postoperative period, it is an inflammatory exudate that slowly turns into an exudate with some characteristics similar to those of lymph.     

Drainless mastectomy: Is it safe and effective?

Practice regarding the use of post operative drains after simple mastectomy varies widely. This project aimed to establish if not using a drain lead to an increase in post-operative seroma formation or other complications. Methods: Women undergoing simple mastectomy ± sentinel node biopsy were included. Patients were allocated to drain/no drain group via operating surgeon. Data was collected retrospectively from computer based records. Drain output, length of stay, seroma formation and volume and post-operative complications were recorded. Results: There were 39 patients in the drain group and 24 patients in the no drain group. Patients did not differ significantly in terms of age, BMI or specimen weight. Seroma was more prevalent in the no drain group (62 v 83%) and required more clinic attendances for aspiration with larger volumes drained (360 vs 725 ml, p = 0.0096). There was no difference in overall complication rate. There did not appear to be a correlation between seroma formation and age, BMI or mastectomy weight. Conclusions: The use of a drain after simple mastectomy may confer lower rates of seroma formation as well as lower overall volumes. Therefore drainless mastectomy appears to be safe but may require more post-operative intervention.     

Glucose concentration in seromas after plastic surgery: A pilot study

Abstract

Previously, glucose concentration has been presumed to be similar in seroma, lymph, and plasma. However, there are few studies actually measuring glucose concentration in seroma. The aim of this pilot study was to determine if the glucose concentration in seroma is similar to that in plasma, as it has previously been presumed. Biochemical analysis of seroma was performed on 11 patients that had undergone plastic surgery. Fluid was taken from the drains between postoperative day 3 and 6. The median glucose concentration was 3.09 millimolar (mM) (range 2.25–3.89 mM). Glucose concentration in seroma does not seem to be similar to that of plasma and lymph that has previously been presumed. The result of this pilot study warrants further investigation to determine the span of normal glucose concentration, its development over time, its relation to plasma glucose concentration, and how it is affected by infection.