Prevention of subcutaneous seroma formation in open ventral hernia repair using a new low-thrombin fibrin sealant.

BACKGROUND Seroma formation is a frequent postoperative complication following open ventral hernia repair (OVHR), especially in cases requiring wide subcutaneous dissection (WSD). The aim of this study was to evaluate the effectiveness of a new low-thrombin fibrin sealant for seroma prevention. METHODS A total of 60 consecutive patients with median incisional hernias who required OVHR with WSD of at least 100 cm(2) were included in the prospective non-randomized study. The fibrin glue group (FG) comprised 30 patients who had undergone OVHR with sublay mesh placement as well as subcutaneous application of low-thrombin fibrin sealant. This cohort of patients was compared with a control group (CG) of 30 consecutive patients who had previously undergone OVHR without prevention of seroma formation with regard to outcome measures such as seroma formations and wound complications. RESULTS Though the median extent of subcutaneous dead space was larger in the FG than in the CG (229 vs.174 cm(2); p = 0.012), seroma formation occurred in three of the FG versus 16 of the CG patients (p = 0.003). Postoperative wound complications occurred in two of the FG versus nine of the CG patients (p = 0.002). Four patients in the CG and none in the FG required re-operation within 30 days (p < 0.001). CONCLUSION The use of a new low-thrombin fibrin glue demonstrated a protective effect against formation of seromas and decreased the rate of wound complications in OVHR, with consecutive shorter length of hospital stay (5.8 vs. 10.4 days; p = 0.04).