Deep seroma after incisional hernia repair. Case reports and review of the literature.

AIM:Wound-related complications are common after incisional hernia repair with mesh; seroma formation is the most frequent problem. The formation of a deep seroma has been rarely reported in the literature. MATERIAL OF STUDY: In one year, September 2012-2013, 136 patients underwent surgery for incisional hernia repair, both elective and urgent. RESULTS: The following complications were observed: one dislocation of polypropylene prosthesis, a massive relapsed seroma and two deep seromas described in this article. A 63- years-old female underwent open incisional hernia repair with an intraperitoneal PTFE patch. She developed recurrent seroma under the mesh drained percutaneously, and finally the prosthesis was removed. A 72- years-old male underwent open incisional hernia repair with an intraperitoneal PTFE patch. After several months the patient had seroma infection. The prosthesis was then removed. CONCLUSIONS: Seroma is a wellknown complication of postoperative ventral hernia repair, especially where prosthetic mesh is used. The formation of a deep seroma is rare. Only few works mention this complication in literature. In the development of these chronic seromas a role may be played by a long-term inflammatory reaction, more pronounced with polypropylene and polyester meshes than with ePTFE. A conservative follow up of the seromas is recommended because drainage can introduce infection. In cases where the seroma causes discomfort or is infected then drainage is necessary. From experience at our institution we suggest that patients with the deep subtype of mesh-associated seromas may require closer clinical follow up. When possible, we recommend attempting the drainage of the liquid, eventually followed by microbiological examination.