Ryu Matsumoto
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,1 Yoshio Nagahisa,1 Kazuki Hashida,1 Mitsuru Yokota,1 Michio Okabe,1 and Kazuyuki Kawamoto1
Abstract

Purposes. Seroma is a postoperative complication complying with laparoscopic transabdominal preperitoneal repair (TAPP) for inguinal hernioplasty. Seroma normally resolves in many cases, yet it can lead come an increased amount of access time to the outpatient clinic and also can result in stress of the patient. Neighborhood inflammation that the inguinal area is etiology that seroma formation. Strangulated hernia involves severe inguinal pain and can lead to severe inflammation and also subsequent seroma. There have been no reports demonstrating the web links of seroma and strangulated hernia. This examine aimed come retrospectively evaluate the danger of seroma after TAPP and also to determine the association in between strangulated hernia and also seroma. Methods. We treated 300 inguinal hernias by TAPP in between 2013 and 2016 at Kurashiki central Hospital. We offered the Chi-square test. Factors far-ranging in each association were more examined utilizing multiple succeeding logistic regressions. Results. A total of 222 hernias to be eligible for analysis. The incidence the seroma to be 11% (n=25). There were nine situations of strangulated hernias, and also three (33%) brought about seroma. The ratio of strangulated hernia the seroma group is substantially high (p Conclusion. This study reflects that strangulated hernia have the right to be a risk factor in seroma formation. This risk should be incorporated into a management plan of TAPP for strangulated hernia, with careful consideration of patients’ concerns.

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1. Introduction

Seroma is a postoperative complication adhering to laparoscopic transabdominal preperitoneal repair (TAPP) for inguinal/ femoral hernioplasty. Seroma normally resolves in many cases, yet it have the right to lead come an boosted amount of access time to the outpatient clinic and also can an outcome in tension of the patients because they misunderstand seroma together recurrence that hernia. A remaining liquid hernia sac during the operation is a major risk that seroma. Moreover, regional inflammation that the inguinal area resulting from dissection that the preperitoneal layer and also the use of prosthetic materials to sheathe the myopectineal orifice have actually been reported as etiologies that seroma formation. However, the an accurate etiology that seroma demands to it is in clarified. Strangulated hernia is a usual disease, i beg your pardon is frequently observed in surgery and the emergency room, and also involves serious inguinal pain. Strangulated hernia have the right to lead to major inflammation and subsequent seroma. Consensus on the surgical approach for strangulated hernia is yet to be reached.

This research aimed to retrospectively evaluate the threat of seroma ~ TAPP and to recognize the association in between strangulated hernia and also seroma. Come the best of our knowledge, this is the very first report to demonstrate that strangulated hernia have the right to be a risk variable of seroma.

2. Materials and Methods

This retrospective examine was carried out at one institution. We obtained written educated consent because that the inclusion of data from all of the participating patients.

We perform approximately 12,000 elective surgeries and 600 emergent surgeries in our hospital every year. We treated 300 adult inguinal/ femoral hernias by TAPP in between 2013 and 2016 at Kurashiki central Hospital. Us excluded patients’ data if there was no details on the size of the hernia, i beg your pardon is associated with the hazard of seroma <1>. We also excluded patient with merged surgeries due to the fact that we might not exactly evaluate the postoperative pain and also complications after multiple surgeries. We examined all patients visually for signs of inguinal swelling, and also by palpation in the outpatient clinic ~ above postoperative work 7, and further investigation by ultrasonography or computed tomography (CT) to be undertaken in patients with findings suggestive that seroma (Figure 1).


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The diagnosis of strangulated hernia was based upon physical examination such together painful palpable bulge and/or nonreducible massive of the inguinal region. Us performed the emergent surgical procedure for the nonreducible hernia, yet for the reducible strangulated hernias we performed the beforehand elective surgical treatment (within 48 hrs from the diagnosis) ~ the preoperative evaluation. Laparoscopy permitted for to know of hernia sac materials (small intestine or omentum). Strangulated hernias were lessened using a combination of manual and laparoscopic manipulation. If the resection of small intestine or omentum to be required, we firstly performed inguinal repair with mesh. The hernias end 3cm in diameter were defined as large hernias and the hernias much less than 3cm were identified as little hernias. The nurse at every surgical unit evaluated the postoperative pains score with the intuitive analogue scale (VAS) 0 and 6 hrs after, and on the next day after the operation. The largest score was identified as VAS MAX. Us allocated the situations to two groups (VAS MAX1).

We allocated the patients right into the seroma and no seroma group. The patient’s demographics included gender, age, and body mass index (BMI). Hernia data to be collected around position that the hernia, kind of hernia, hernia anatomy, strangulated hernia, and also size of hernia. Procedure time, airway device, intraoperative complication, mesh type, VAS MAX, and analgesic usage were examined as intraoperative and postoperative data.

2.1. Operation Procedures

Preoperative antibiotic management was carry out to only the strangulated cases. All surgeries to be undertaken through 3 ports utilizing a strict endoscope (30°) under basic anesthesia. A urinary catheter was offered only when required. Ab CO2 push was created as 10 mmHg throughout the procedure. We dissected the preperitoneal layer utilizing the Sandwich approach, due to the fact that it is feasible because that patients with significant adhesion and also is able to it is in safely carry out by young surgeons <2>. Us dissected every the hernia sac and did no retract the transversalis fascia. We provided two types of mesh: L dimension 3DMax mesh (Bard, Cranston, RI) and M size Parietex anatomical mesh (Covidien, Mansfield, MA). In strangulated hernias, the very same mesh was additionally used after evaluation as a clean operation. Every mesh was addressed with AbsorbaTack (5-mm fixation device; Covidien) at the very least on the Cooper’s ligament and also transverse abdominal muscle muscle. After fixation with mesh, we included dissection if essential to reduce the redundant body organ incision and also the procedure time. The peritoneal flap was closed through 3-0 Vicryl in all cases. Every surgeries to be performed by surgical citizens with 3–5 year of experience, and who were managed by an experienced physician who likewise operated as a scopist.

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2.2. Statistical Analyses

All statistical analyses were performed with Statistical Package because that Social scientists software variation 21.0. Associations in between position that the hernia, kind of hernia, hernia anatomy, strangulated hernia, dimension of hernia, airway device, mesh type, vas max, and analgesic use and seroma to be calculated by Chi-square test. P3. Results

After the exclusion, 222 hernias to be eligible for evaluation (Figure 2).