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Endoscopic-assisted Debridement as a Definitive Treatment for Recurrent Fluid Collections After Ventral Hernia Repair

Manuel Garcia, MD, Jeffrey Quigley, DO, Daniel Srikureja, Marcos Michelotti, MD, FACS. Loma Linda University Health

Introduction: Seroma formation and subsequent mesh non-incorporation are troublesome complications after complex ventral hernia repair with synthetic mesh placement.  Although many times seroma will resolve spontaneously, failure of medical management often necessitates surgical intervention.

Case report: 39 year male presented with large ventral and parastomal hernia 2 years after end colostomy takedown with protective ileostomy performed after Hartmann’s procedure 3 years ago.  Past medical history included GERD, HTN and Morbid obesity (BMI 38.5 kg/m^2).  The patient was offered ileostomy takedown, as well as ventral and parastomal hernia repair using a Tranversus Abdominus Release and retro-rectus composite mesh repair.  Despite surgical drain placement with routine removal at 2 weeks, the patient returned 3 months post op with seroma, which was treated with percutaneous drain.  By 6 months, a deep seroma had reformed in the retro-muscular space and a portion of the mesh was non-incorporated.  The patient was re-operated with endoscopic debridement of the non-incorporated mesh as well as irrigation and drainage of the seroma without violating the primary closure of the abdominal wall.  A wound VAC was applied through one of the incisions, and two closed suction drains were left, being removed at around 2 and half weeks.  At three months the patient demonstrated complete resolution of the seroma.

Discussion: Failure of seroma to respond to non-operative management represents a challenge in the post-operative management of patients undergoing complex ventral hernia repair.   Open surgical intervention to explant non-incorporated mesh frequently leads to recurrence.  Only very small case series are currently available to describe an endoscopic approach to this complication.  We report a satisfactory outcome with endoscopic approach which combined partial mesh explantation and washout and drainage of the seroma cavity, with the benefit of avoiding alteration to the anatomy of the primary closure and avoiding recurrence.


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 88454

Program Number: P002

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

40

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