I had 2 large RLQ/inguinal hernias repaired with Alloderm 4 weeks ago. Large seroma (200-300 cc) was drained a week ago. I had some relief, but now, a week later, it feels the same: hard and painful. Surgeon seems reluctant to attempt draining again, and he says it will just fill back up. Now what?
Recurring Seroma After Hernia Repair with Alloderm
Doctor Answers 4
Treatment of chronic seroma cavity
Only my opinion & experience and insights. Take it for what it's worth.
If there is foreign material especially gortex ptfe it may never resolve until it is removed. If it is polypylene mesh, you can heal around it. Any other foreign body or permanent suture may eventually require removal.
Regional radiation makes it nearly improssible to heal. Make sure there are no fistulas. Instillation of tetracycline or talc or both as a sclerosing agent with percuatenous drain may be useful followed by pressure dressing.
If this does not work, open treatment may be necessary. In this instance pull out all the stops:
1) excise pseudobursa
2) apply surgical talc to surfaces
3) qulting sutures to obliterate dead space
4) external bolster (tie over dressings)
5) gentle external compression
In one instance of chronic inquinal seroma following lymphadenectomy, I performed a lymphangiogram to identify and ligate the "leaking" lymphatics.
Best of luck! I hope this is useful to you.
Alloderm could cause seromas
One of the side effects of alloderm is seroma. In general, drainage is done with aspiration and compression. You might want to discuss the treatment futher with you surgeon.
A few options for seroma problems
For chronic seromas, you usually need to excise the seroma cavity to prevent recurrence. The other options that you can try first include inserting a new drainage tube and placing it to bulb suction. If the seroma is obvious, you can place the drain by palpation percutaneously. You can use the Seldinger Technique (over a wire or guide) for the safest access.
Alternatively, if there is question about the anatomic location of the seroma, then you or an interventional radiologist can place a drain by ultrasound or CT guidance. Once the drain is in place, you will need to keep it in place and on suction (bulb) until the output is minimal. If the area continues to drain, then you can try sclerosing the seroma cavity with tetracycline solution.
However, if these methods do not work, then you will need to re-operate to remove the seroma cavity. When you close the incision, place a new drain. Good luck.
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Recurring seroma after hernia repair will heal
As was stated below, smooth surface meshes (Alloder, Goretex etc) are associated with recurrent fluid collections (seromas). These do not resolve until the mesh is surrounded by scar tissue (a capsule) and the inflammatory response has subsided. The only treatment is drainage to allow the walls of the cavity to touch each other, compression garments (to maintain this contact until scar keeps it there) and a good dose of PATIENCE. It will heal.
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