Abdominal Hernia Surgery with Mesh, Formed Seroma, Drained X10, Alcohol Ablation X4, Surgery Removed Seroma, Still Filling Up?

     Whenever a seroma has recurred after all of these measures, there may be another reason for this.  Is there an issue with nutrition or low protein or albumin in the blood?  Is there liver and kidney abnormality?   Are there any other endocrine abnormalities?  If there is nothing else systemically, another operation could be proposed.   Mesh is an option for reconstruction.  Some dermal matrices are used as well.  A components separation would be another option.  Kenneth Hughes, MD Los Angeles, CA

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

Chronic recurrent seromas are rare and are hard to treat.  It sounds like most of the standard measures including reoperation are being done.  They might want to culture the fluid to be sure there isn't an infection causing the persistent irritation. Also intraabdominal pathology causing fluid to come through the mesh into the subcutaneous space should also be ruled out.  I'd go to a major university teaching program in plastic surgery and talk to their abdominal wall reconstruction expert at this point.