I Had Abdominal Hernia Surgery, Now I Have a Large, Painful Seroma. Options?

Question

After abdomanal hernia surgery I am left with this huge seroma that is as large as a melon. It is painful. Is this normal? The surgeon suggested a tummy tuck. Someone else would be doing the tuck. Should I as him to pay for this. I have limited income.

Matthew Schulman, MD · Answer

I agree with the other docs who said that something sounds fishy. A seroma is a collection of fluid. It needs to be drained, either with needle aspirations, placement of a drain, or open drainage. A tummy tuck is completely unrelated. Your surgeon (I presume a board certified general surgeon) should deal with with complication without suggesting that you undergo an elective cosmetic procedure. If your original surgeon is not willing - or capable - of dealing with this common complication, then you need to seek another doctor.

Richard J. Bruneteau, MD · Answer

It’s unusual
for patients to develop seromas when they undergo abdominal hernia
repairs. Occasionally seromas may be
seen following this procedure when the soft tissue has been extensively
undermined for exposure.Under these circumstances, treatment
of the seroma is necessary before secondary procedures should be
considered.Treatment usually requires
serial percutaneous aspirations.In some
cases, CT guided drain placement is appropriate.If patients continue to have loose
skin following wound healing and seroma resolution an abdominoplasty is a
consideration.Abdominoplasty shouldn’t
be considered a treatment for seromas, but instead a treatment for loose skin.Under these circumstances, it’s
appropriate to consult a board certified general surgeon.This surgeon should be able to manage both
your hernia repair and your seroma.If
residual aesthetic deformities are present after complete wound healing,
abdominoplasty may still be an option.

J. Jason Wendel, MD, FACS · Answer

Thank you for your question. It is not necessary to have a tummy tuck to resolve a seroma. If you indeed have a painful seroma as a result of your hernia repair, then you should return to see the surgeon who did the hernia repair to address the seroma through surgical or non-surgical drainage. I hope this helps.

Richard H. Tholen, MD, FACS · Answer

Many plastic surgeons are fully trained general surgeons (I was certified by the American Board of Surgery in 1986) prior to their plastic surgical training and certification, so we can offer proper advice regarding your situation.

	If you have fluid under your skin following hernia repair, this could be a seroma, or it could be an indication that your hernia repair has partially or completely broken down, allowing peritoneal fluid (the fluid around your intrabdominal organs) to collect under the skin through what may be a recurrent hernia opening in your abdominal wall.

	Difficult hernias are sometimes referred for specialized reconstructive procedures performed by a plastic surgeons (fully-trained ABPS-certified plastic surgeons are experts in reconstructive surgery as well as cosmetic surgery), but this is not elective tummy tuck cosmetic surgery.

	Your general surgeon may be trying to deflect responsibility for your present troubles, or may simply be advising referral to a specialist with more surgical tools to attack your problem. It could be that he was simply trying to describe a plastic surgical reconstructive approach in terms he hoped you would understand (since most lay people have heard about tummy tucks), but is really saying he needs help from a reconstructive plastic surgeon consultant in your care. Insurance should cover continued care of your hernia-related problems and additional surgery (by either kind of surgeon--General or Plastic).

	Often small or asymptomatic hernias are repaired by a plastic surgeon during the course of an elective cosmetic tummy tuck, but this can and should be part of your original hernia care. Talk to your general surgeon; if he really wants you to see a plastic surgeon, it's not for a "cosmetic" tummy tuck; it's for hernia reconstruction by different means. Also, be careful about any surgeon sticking needles into this "fluid-filled" cavity--it could be bowel!

Jeffrey M. Darrow, MD · Answer

You should return to your original surgeon, who should take respondsibility for your post operative care and treat the seroma until it is resolved. An abdominoplasty during this early post operative period is not indicated and could potentially lead to increased complications.

Pablo Prichard, MD · Answer

Thank you for your post.  Seromas can be painful and cause a cosmetic deformity, as well as sometimes leak.  The whole point of drains is to keep a seroma from happening in the first place.  If a drainless procedure was performed, and you had a seroma, or you had drains that were pulled and you subsequently had a seroma, then you should be drained, otherwise a capsule builds around the fluid making it permanent.  If a capsule builds around the seroma (pseudo bursa or encapsulated seroma) then the only way to remove the seroma is to surgically open the areas and excise the capsule, and close over drains to prevent another seroma from happening.  If the seroma is encapsulated and is tight and painful, then it can be confused with just swelling or fat.  An ultrasound is useful in distinguishing these and identifying the extent of the seroma. If the seroma is not yet encapsulated, then it is usually loose and has a 'fluid wave' or water bed type feel.  Occasionally, a seroma can also become infected, especially if a permanent braided suture was used.  This will have a hot, red appearance, and will eventually open up.  I have never seen an infection from sterile aspiration of fluid.  If seromas continue despite multiple aspirations over an extended period of time, then you need to start thinking about re-openning the incision and excising the entire capsule, both from and back walls, to treat the seroma.  Drains need to be placed, internal sutures placed, possibly using a tissue glue or irritant to encourage the tissues to grow together.Best wishes,Pablo Prichard, MD

Karol A. Gutowski, MD, FACS · Answer

Something does not sound right. Your hernia surgeon should be able to deal with the seroma or refer you to a plastic surgeon for treatment of the seroma. No one should talk you into a tummy tuck unless that is what you want. Perhaps you should get a second opinion. Also, if insurance covered the hernia repair, it should cover treatment of the seroma.

Tom J. Pousti, MD · Answer

I'm sorry to hear about the complication you are experiencing.

	Your surgeon should be treating the seroma  by aspirating the fluid.  Sometimes multiple aspirations are necessary. Occasionally,  it may be necessary to place a drain. 

	The situation is even more complicated if mesh was used for the hernia repair;  and infection would be a very unfavorable secondary complication.

	At this point, you should not be considering tummy tuck surgery.

	Best wishes.

Richard P. Rand, MD, FACS (retired) · Answer

As the others have said, a common seroma does not require a tummy tuck for treatment. If you had needed a tummy tuck, it could have been done with the original hernia repair also. Seromas (if that is actually what you have) need to be drained and if that is not successful, the lining of the cavity needs to be excised and drained. Be careful not to assume that a seroma is the diagnosis and not a recurrent hernia. Sounds like you need some other consultations.

Ronald V. DeMars, MD (Retired) · Answer

A seroma is a collection of body fluid called serum and is seen sometimes after the abdoninal skin and fat is lifted up off the muscles as we do for a tummy tuck or you had done to repair the hernia. It is a direct result of the surgery and should be treated until it is completely resolved by the original surgeon at no additional cost to you or your insurance carrier. You may want to get them involved in this. The treatment of such a large seroma would generally be a drain for some period of time that could be even a few weeks. If your surgeon really won't treat you then you may want to get in touch with his employer, and if he is in private practice you may need to contact the state medical board, but I doubt it will come to that if you just speak with the doctor further.

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