Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial

Westphalen, André Pereira; Araújo, Allan Cézar Faria; Zacharias, Patrícia; Rodrigues, Eduardo Silva; Fracaro, Geanine Baggio; Lopes Filho, Gaspar de Jesus

doi:10.1590/S0102-865020150120000009

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Acta Cirúrgica Brasileira

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ORIGINAL ARTICLES • Acta Cir. Bras. 30 (12) • Dec 2015 • https://doi.org/10.1590/S0102-865020150120000009 copy

Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial ^¹ 1 Research performed at Hospital Universitário do Oeste do Paraná (HUOP), Universidade Estadual do Oeste do Paraná (UNIOESTE), Cascavel-PR, Brazil. Part of Master degree thesis, Postgraduate Program in Interdisciplinary Surgical Science, Universidade Federal de São Paulo (UNIFESP). Tutor: Gaspar de Jesus Lopes Filho.

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

PURPOSE:

To evaluate the occurrence of seroma and surgical wound infection after surgery.

METHODS:

A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery.

RESULTS:

The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999).

CONCLUSION:

The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.

Key words:
Hernia; Ventral. Seroma; Drainage; Suture Techniques; Herniorrhaphy

Sociedade Brasileira para o Desenvolvimento da Pesquisa em Cirurgia https://actacirbras.com.br/ - São Paulo - SP - Brazil
E-mail: actacirbras@gmail.com

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[1] Correspondence: André Pereira Westphalen Rua Castro Alves, 2817 85811-060 Cascavel - PR Brasil Tel.: (55 45)9135-1082 Fax: (55 45)3038-4001andrewestphalen@terra.com.br

	Group 1 (n = 21)		Group 2 (n = 21)			Total (n = 42)		p
Gender
female	15	71.4%	14	66.7%	29	69.0%	0.739^a
male	6	28.6%	7	33.3%	13	31.0%
Age (years)
mean	55.5		52.4			54.0		0.421^c
median	57.0		54.0			55.5
minimum-maximum	36.0-71.0		26.0-78.0			26.0-78.0
standard deviation	10.6		13.9			12.3
BMI classification
normal^g	1	4.8%	5	23.8%	6	14.3%	0.278^b
overweight^h	7	33.3%	6	28.6%	13	31.0%
obeseⁱ	13	61.9%	10	47.6%	23	54.8%
Smoking
yes	4	19.0%	6	28.6%	10	23.8%	0.469^a
no	17	81.0%	15	71.4%	32	76.2%
Cardiac risk
I	13	61.9%	16	76.2%	29	69.0%	0.317^a
II	8	38.1%	5	23.8%	13	31.0%
Serum albumin^j (g/dL)
mean	3.9		3.8			3.9		0.434^c
median	3.9		3.8			3.9
minimum-maximum	3.4-4.7		3.1-4.7			3.1-4.7
standard deviation	0.3		0.5			0.4

	Group 1 (n = 21)			Group 2 (n = 21)			Total (n = 42)	p
Hernia size (cm)
mean	9.4			9.3			9.3	0.950^d
standard deviation	3.2			3.2			3.2
Subcutaneous fat thickness (cm)
mean	3.5			2.8			3.1	0.131^d
standard deviation	1.2			1.4			1.3
Hernia defect area (cm²⁾
mean	40.8			41.8			41.3	0.910^d
standard deviation	26.1			31.2			28.4
Surgical time (minutes)
Mean	114.3			124.0			119.1	0.310^c
Standard deviation	24.5			35.4			30.5
Early postoperative US
without seroma	17	81.0%	15	71.4%	32	76.2%	0.469^a
with seroma	4	19.0%	6	28.6%	10	23.8%
infection	-	-	-	-	-	-
Intermediate postoperative US
without seroma	7	33.3%	6	28.6%	13	31.0%	0.843^b
with seroma	10	47.6%	12	57.1%	22	52.4%
infection	4	19.0%	3	14.3%	7	16.7%
Late postoperative US
without seroma	6	28.6%	7	33.3%	13	31.0%	0.852^b
with seroma	11	52.4%	9	42.9%	20	47.6%
infection	4	19.0%	5	23.8%	9	21.4%

	with infection (n = 9)		without infection (n = 33)		Total (n = 42)		p
Use of drain
yes	4	44.4%	17	51.5%	21	50.0%	> 0.999^b
no	5	55.6%	16	48.5%	21	50.0%
Gender
female	7	77.8%	22	66.7%	29	69.0%	0.695^b
male	2	22.2%	11	33.3%	13	31.0%
Age (years)
mean	53.1		54.2		54.0		0.815^c
standard deviation	12.1		12.5		12.3
BMI classification
normal	1	11.1%	5	15.2%	6	14.3%	0.676^b
overweight	4	44.4%	9	27.3%	13	31.0%
obese	4	44.4%	19	57.6%	23	54.8%
Cardiac risk
I	5	55.6%	24	72.7%	29	69.0%	0.422^b
II	4	44.4%	9	27.3%	13	31.0%
Hernia size (cm)
mean	10.6		9.0		9.3		0.181^d
standard deviation	2.5		3.3		3.2
Subcutaneous fat thickness (cm)
mean	3.2		3.1		3.1		> 0.999^d
standard deviation	1.8		1.2		1.3
Smoking
yes	4	44.4%	6	18.2%	10	23.8%	0.181^c
no	5	55.6.%	27	81.8%	32	76.2%
Recurrent hernia
yes	3	33.3%	7	21.2%	10	23.8%	0.660^c
no	6	66.7%	26	78.8%	32	76.2%
Surgical time (minutes)
mean	136.3		114.4		119.1		0.055^c
standard deviation	28.7		29.7		30.5