Proposal of ecographic classification for seroma after laparoscopic ventral hernia repair

Abstract

Introduction Seroma is one of the most common complications after laparoscopic ventral hernia repair (LVHR), even if the incidence brought in literature is varying because definition and criterions of evaluation employed in the different studies are not always the same. This study proposes a classification for seroma after LVHR based on ultrasound findings, useful for an assessment of this complication. Materials and methods On 93 patients submitted to LVHR an ultrasound of the abdominal wall after 3, 7, 15, 21 and 28 days and subsequently at a distance of 3 and 6 months was performed postoperatively. At each control site, sonomorphology characteristics and size of seroma (if present) were noted. Results At the end of the study using ultrasound findings obtained, a classification scheme for seroma articulated into three groups based on the parameters detected (site, sonomorphology character and volume) was developed, each of which is subdivided into five different classes to which a precise score is assigned. From the sum of the scores assigned, a value (between 3 and 15) that represents a prognostic index (PI) is obtained. A low PI is typical of small asymptomatic seroma that resolves spontaneously in a short time and without the need for invasive therapies; a high PI is typical of more or less symptomatic voluminous seroma that tends to persist for long periods and which often requires an interventional therapeutic approach. Conclusions This proposed classification helps to perform a precise nosological assessment of seroma after LVHR, allowing the surgeon to predict the clinical and temporal evolution of this complication and to plan appropriate therapy from time to time. Furthermore this classification can represent a tool to assess the uniqueness of seroma formation in relation to surgical technique used, to the type of material employed and to the method of mesh fixing.Keywords Ventral hernia Á Laparoscopic repair Á Seroma Á Ultrasound classification Sommario Introduzione Il sieroma è una delle complicanze più comuni dopo la riparazione laparoscopica delle ernie ventrali (RLEV), anche se l'incidenza riportata in letteratura è alquanto variabile perché la definizione e i criteri di valutazione impiegati nei diversi studi non sono sempre gli stessi. Proponiamo una classificazione dei sieromi dopo RLEV basata sui rilievi ecografici, che consenta un inquadramento condivisibile di questa complicanza. Materiali e Metodi Su 93 pazienti sottoposti a RLEV è stata eseguita un'ecografia della parete addominale dopo 3, 7, 15 21 e 28 giorni e successivamente a distanza di 3 e 6 mesi dall'intervento. Ad ogni controllo sono state annotate sede, caratteri ecosemiologici e dimensioni del sieroma (se presente). Risultati Alla fine dello studio grazie a tutti i rilievi ecografici ottenuti è stata elaborato uno schema classificativo dei sieromi basato su 3 parametri (sede, caratteri ecosemiologici e volume), ciascuno dei quali suddiviso in 5 diverse classi a cui viene attribuito un preciso punteggio. Dalla somma dei p...

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