A new classification for seroma after laparoscopic ventral hernia repair.

INTRODUCTION: Laparoscopic techniques are being used increasingly in the repair of ventral hernias, but different incidences and complications have been described as potential risks of this approach. Seroma formation has been documented as one of the most common complication, although most of the time remains asymptomatic and it can be considered just an incident. The incidence of seroma after laparoscopic ventral hernia repair has not been properly documented and analyzed since the definition used by different authors is not the same from one series to another. We present a new classification of clinical seroma in order to try to establish the real incidence of this potential complication. CLINICAL CLASSIFICATION: Clinical seromas could be detected during physical examination in many patients after LVHR, but in most of the cases they do not cause any problem or just a minimum discomfort that allows normal activity. Based on this fact and on the need of carrying out a medical or an invasive therapy to treat them, five groups can be established in order to classified this entity: Type 0, no clinical seroma (being 0a no seroma after clinical examination and radiological examinations and 0b those detected radiologically but not detected clinically); Type I, clinical seroma lasting less than 1 month; Type II (seroma with excessive duration), clinical seroma lasting more than 1 month (being IIa between 1 and 3 months and IIb between 3 and 6 months); Type III (symptomatic seromas that may need medical treatment), minor seroma-related complications (seroma lasting more than 6 month, esthetic complaints of the patient due to seroma, discomfort related to the seroma that does not allow normal activity to the patient, pain, superficial infection with cellulites); and Type IV (seroma that need to be treated), mayor seroma-related complications (need to puncture the seroma, seroma drained spontaneously, applicable to open approach, deep infection, recurrence and mesh rejection). It is important to differentiate between a complication and an incident, being considered seroma as an incident if it is classified as seroma Type I or II, and a complication if it is included in group III and IV. The highest classification is the one that should be used in order to describe the type of seroma.
CONCLUSIONS: Seroma is one of the most common complications after laparoscopic ventral hernia repair although its real clinical incidence is variable since it has been described in the literature following different parameters. It is observed in almost all cases by radiological examinations, but it is not determined if must be considered an incident or a complication. For these reasons, a new classification of seroma has been proposed in order to unify criteria among surgeons when describing their experience. This classification could be also used in the future to measure the effect of new methods proposed to reduce seroma formation to evaluate the incidence of seroma depending on the mesh used, and it could be also proposed to be used to describe the incidence of seroma after open ventral hernia repair.