Use of vacuum-assisted closure in open incisional hernia repair: a novel approach to prevent seroma formation

Abstract

Frequent complications in incisional hernia surgery are re-herniation, wound infection and seroma formation. The use of subatmospheric pressure dressings such as the vacuum-assisted closure (VAC) device has been shown to be an effective way to accelerate healing of various wounds. Here, we describe the application of the VAC device as a postoperative dressing to prevent seroma formation after open incisional hernia repair. Three consecutive patients (63, 65 and 60 years of age, respectively) underwent incisional hernia repair. Patient body mass index was 30.9, 26.6 and 29 kg/m(2), respectively. All hernias were complex with a defect size greater than 10 cm and were repaired using the onlay technique. After suture skin closure the incision was covered with a thin VAC sponge (KCI, San Antonio, TX) that was set at -125 mm Hg and left in place for 5 days before removal. An abdominal CT scan performed before discharge from the hospital did not show seroma formation. Physical examination 3 months after surgery was normal with no evidence of seroma (abdominal bulge and/or fluid wave). This successful preliminary experience in three patients encourages the use of the VAC system in incisional hernia repair, particularly in selected patients with risk factors for seroma formation (e.g., large defects, obesity, patient comorbidities, nutritional status, number of prior abdominal incisions, etc.). Therefore, prevention of seroma formation after incisional hernia repair may be added as a novel application of the VAC device.