I Had Surgery About a Year Ago to Fix a Hernia with Diastasis (Twin Pregnancy)- Now, Have a Build Up Of Fluid. What Do I Do?

Since the surgery/drain removal, I've had reoccuring fluid collections.I've had CT-guided drainage 4x in the last year and then sent home w/drains for 1-2 weeks each time.It's been 2 months since the last one and I now have a huge pocket of fluid again. It hurts to touch my stomach. One surgeon said she wants to remove the mesh and drain the fluid by opening me completely up again.Another surgeon said to leave it and to manage it with pain meds and it will go away on it's own. What do I do?

Doctor Answers 3

Tummy Tuck - I Had Surgery About a Year Ago to Fix a Hernia with Diastasis (Twin Pregnancy)- Now, Have a Build Up Of Fluid. What

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I'm very sorry about your course since your surgery.

Unfortunately, though, a chronic seroma - which is presumably what you have at this point - requires surgery for correction.  In general, you need to have the scar tissue that's formed around the fluid (the "pseudobursa") removed - that's part of why the fluid keeps accumulating - along with anything that may be contributing to the fluid, such as the mesh.  It seems radical, but a foreign body and/or the scar tissue alone can keep the seroma going.  Having both sources is that much more of a problem.

You may need to take a few steps back before you can move forward again, and I suspect that that means removal of the seroma, the pseudobursa and the mesh, then allow your tissues to heal and then - if necessary and indicated - consider having the mesh put back in.  Sometimes, despite having needed it before, you may not need it again.  And that would be the best scenario of all.

I hope that this helps, and good luck,

Dr. E

Chronic Seroma After Tummy Tuck

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Thank you for the question.

I'm sorry to hear about all the trouble you have been experiencing since your  surgery. Unfortunately, at this point I think  the only good option is to surgically drain the seroma,  excise the scar tissue around the seroma, remove the mesh, suture the abdominal wall flap back to the abdominal wall fascia (to promote adherence of the flap to the underlying fascia)  and use several drains. 

I hope this helps.

Managing Recurring Tummy Fluid collections after Hernia Repair with a Mesh

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From your question I understand you to have had a Tummy Tuck requiring a mesh repair of a large hernia a year ago which was followed 4 times by large fluid collections treated each time by CT scan guided insertion of drains but the fluid continues to form. The most recent fluid collection is "huge" and you have been told by one surgeon it would get better by leaving things alone while the other surgeon suggested the mesh needs to be removed completely.

The use of mesh repair in Tummy Tuck surgery is rare and your case clearly demonstrates why we should use mesh with caution. There is NO doubt in my mind that large recurrent seromas with a mesh CANNOT be treated conservatively. By this time, the fluid pocket formed a smooth scar lining and is termed a CHRONIC BURSA. Even if the cavity was drained several more times or was injected with caustic substances to cause irritation of the cavity walls to promote adherence, the odds are the mesh may be infected by now and the only way to solve this problem is to open the seroma pocket, remove the smooth scar lining, remove the mesh, control all bleeding points, pulse irrigate the cavity of all particulate and microscopic matter and microbes and close the wound over drains.

Good Luck.

Peter A Aldea, MD

Peter A. Aldea, MD
Memphis Plastic Surgeon

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