Prospective Randomized Study for Comparison of the Outcome of Suction versus Non-Suction Closed Drainage on Seroma Development after Open Onlay Ventral Hernioplasty in 100 Patients

Abstract

Introduction: There isn't a widely used definition for seroma but “serous fluid collection in a body space, tissue or organ occurring after surgery or trauma”, is defined as seroma. Symptomatic seromas are common in laparoscopic and open ventral hernia repairs, presented in 8 to 12.5% of patients after open repair by clinical examination at the 8 weeks post-operative control. Several operative measures were done to reduce the development of postoperative seromas after hernia repair as an intra-operative technical step (e.g. quilting sutures) or adjunct procedure (e.g. drain application). During ventral hernias repair, surgeons regularly insert a surgical drain to allow the fluid drainage. Closed drains can be either active (suction) drains or passive (non-suction) drains. Methods: During the period from August 2018 to October 2019, a total of 100 adult patients presented with different types of ventral hernias, underwent open onlay mesh hernioplasty in the gastrointestinal surgery unit, general surgery department, Tanta University. Patients included in this study were randomly allocated into one of the following two groups using the closed envelope method. Group A included 50 patients with suction tube drain and group B included 50 patients with non-suction tube drain. Results: There were no statistically significant differences between both groups regarding the patients’ demographics. It was evident that with the use of suction drains from 9th POD the mean daily fluid effluent and the mean total amount of fluid effluent during all follow-up days was significantly lower than in non-suction tube drains. Also, the mean time of drain removal was statistically significantly shorter in group A than in group B. It was found that cases of ultrasonographic and clinically diagnosed seroma, had compensated chronic liver disease, obesity (BMI > 30 kg\m2), multiple previous abdominal incisions, long period of hernia presence (> 4 years), long-standing partial irreducibility, and large dead space after subcutaneous flap dissection. Conclusion: Suction drains were removed at a significantly shorter time than non-suction ones under the same rules of management. It also gives significantly lower volume fluid effluent from the 6th POD onwards. Seroma were harder to manage with non-suction tube drains: longer drainage period, worse resolution rates.