Role of Tranexamic Acid for Seroma Prevention in Obese Patients Undergoing Laparoscopic Ventral Hernia Repair Under Spinal Anesthesia

Objective: The aim of this study is to determine the effectiveness of tranexamic acid for seroma prevention in obese patients undergoing laparoscopic ventral hernia repair under spinal anesthesia. Study Design: Cross sectional study Place and Duration: Jinnah Postgraduate Medical Center (JPMC) Karachi, 1st July 2020 to 30th June 2021. Methods: There were one hundred and ten patients f both genders had abdominal hernia were included in this study. We have taken written consent from all the patients for detailed demographics age, sex and body mass index. Patients were undergone for laparoscopic ventral hernia repair under spinal anesthesia in OPD. The size and contents of the defect were determined by an abdominal and pelvic ultrasound. All patients received postoperative tranexamic acid. Drains were put in to measure the amount of seroma that was produced as a result of the procedure. SPSS 22.0 was used to analyze all of the data. Results: 42.23±6.55 years were the mean age of the patients. Mean Body mass index was 32.13±3.43 kg/m2. Majority of the patients 74 (67.3%) were females and rest of the patients 36 (32.7%) were males. In 91 (82.7%) cases seroma reduction was calculated within week. Only 41 of the 110 patients had drain output of less than 150 ml, 55 had drain output of 150-300 ml, and 14 had drain output greater than 300 ml. Seroma formation was found among 7 (6.4%) cases. Conclusion: Tranexamic acid was found to be efficient in minimizing postoperative seroma formation in ventral hernia repairs, according to the findings of this study. Keywords: Laparoscopic, Tranexamic acid, Plasminogen, Seroma, Obese Patients

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Outcome of laparoscopic ventral hernia repair in morbidly obese patients with a body mass index exceeding 35 kg/m2

Surgical Endoscopy ◽

10.1007/s00464-007-9406-6 ◽

2007 ◽

Vol 21 (12) ◽

pp. 2293-2297 ◽

Cited By ~ 48

Author(s):

I. Raftopoulos ◽

A. P. Courcoulas

Keyword(s):

Body Mass Index ◽

Hernia Repair ◽

Ventral Hernia ◽

Body Mass ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Morbidly Obese ◽

Obese Patients

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Intra-Abdominal Placement of Antimicrobial-Impregnated Mesh is Associated with Noninfectious Fever

The American Surgeon ◽

10.1177/000313480607201210 ◽

2006 ◽

Vol 72 (12) ◽

pp. 1205-1209 ◽

Cited By ~ 5

Author(s):

William S. Cobb ◽

B. Lauren Paton ◽

Yuri W. Novitsky ◽

Michael J. Rosen ◽

Kent W. Kercher ◽

...

Keyword(s):

Body Mass Index ◽

Hernia Repair ◽

Ventral Hernia ◽

Body Mass ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

In Vivo Models ◽

Postoperative Fever ◽

Dual Mesh

The antimicrobial, silver/chlorhexidine, when impregnated on mesh has been demonstrated to resist mesh infection in in vitro and in vivo models. The clinical, human systemic response to intraperitoneal placement of silver/chlorhexidine-impregnated mesh has not been investigated to date. Between October 2002 and November 2004, all in-patients undergoing laparoscopic ventral hernia repair were retrospectively analyzed. All repairs used expanded polytetraflouroethylene (ePTFE) Dual Mesh (DM) or ePTFE impregnated with silver/chlorhexidine, Dual Mesh Plus (DM+). Patient demographics, hernia characteristics, mesh type, operative details, and hospital course data were collected. Noninfectious fevers were defined as a temperature greater than 100.4 F without an identified source. Standard statistical methods were used. During the 2-year study period, 120 patients underwent laparoscopic ventral hernia repair (DM = 55, DM+ = 65). The two groups were similarly matched in terms of age, body mass index, American Society of Anesthesiologists score, defect size, and mesh size. Postoperative fever without an identified source occurred in 10 (18.2%) patients with DM and in 25 (38.5%) patients using DM+ (P = 0.015). A multivariant analysis revealed that only mesh type and body mass index predicted postoperative fever. All fevers resolved within the first 72 hours in the DM patients; however, 16 per cent of the DM+ group had persistent fevers of unknown origin after 72 hours. Within the DM+ group, patients with postoperative fevers had significantly longer postoperative stays (4.8 days vs 3.0 days; P = 0.009). The use of antimicrobial-impregnated ePTFE mesh with silver/chlorhexidine in laparoscopic ventral hernia repair is associated with noninfectious postoperative fever. In our patients, the evaluation and management of these fevers resulted in a significantly longer hospital stay.

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Laparoscopic ventral hernia repair in obese patients under spinal anesthesia

International Journal of Surgery ◽

10.1016/j.ijsu.2013.07.002 ◽

2013 ◽

Vol 11 (9) ◽

pp. 926-929 ◽

Cited By ~ 4

Author(s):

Dimitrios Symeonidis ◽

Ioannis Baloyiannis ◽

Stavroula Georgopoulou ◽

Georgios Koukoulis ◽

Evangelos Athanasiou ◽

...

Keyword(s):

Hernia Repair ◽

Spinal Anesthesia ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Obese Patients

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Sutureless Laparoscopic Ventral Hernia Repair in Obese Patients

JSLS Journal of the Society of Laparoendoscopic Surgeons ◽

10.4293/108680811x13022985131859 ◽

2011 ◽

Vol 15 (2) ◽

pp. 154-159 ◽

Cited By ~ 1

Author(s):

Ehab Akkary ◽

Lucian Panait ◽

Kurt Roberts ◽

Andrew Duffy ◽

Robert Bell

Keyword(s):

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Laparoscopic Ventral Hernia Repair ◽

Obese Patients

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Laparoscopic Ventral Hernia Repair Combined with Sleeve Gastrectomy in Morbidly Obese Patients: Early Outcomes

The Surgery Journal ◽

10.1055/s-0039-1694979 ◽

2019 ◽

Vol 05 (03) ◽

pp. e87-e91 ◽

Cited By ~ 2

Author(s):

Ahmed M.S.M. Marzouk ◽

Heba O.E. Ali

Keyword(s):

Sleeve Gastrectomy ◽

Hernia Repair ◽

Ventral Hernia ◽

Ventral Hernia Repair ◽

Mesh Size ◽

Laparoscopic Ventral Hernia Repair ◽

Abdominal Pressure ◽

Morbidly Obese ◽

Obese Patients ◽

The Mean

Background Morbid obesity is a serious chronic condition with, among other symptoms, increased intra-abdominal pressure and subsequent abdominal wall hernias. The optimal management of these manifestations is still controversial. The objective of this study was to assess the early postoperative outcomes of a surgical approach combining laparoscopic ventral hernia repair (LVHR) with sleeve gastrectomy in morbidly obese patients. Methods In this retrospective study, we reviewed the files of patients who are obese with a primary ventral hernia of less than 10 cm in diameter who received simultaneous laparoscopic sleeve gastrectomy and LVHR at our institution between February 2016 and July 2018. LVHR was performed using an intraperitoneal only mesh. The individual mesh size was chosen based on the number and size of the defects. Clinical and radiological follow-ups were performed between 9 and 15 months. Results A total of 15 patients were included. Five of them were males. The mean body mass index was 45.2 kg/m2 (range: 38.7–56.2 kg/m2). The mean hernia defect size was 2.6 cm (range: 1.3–4.2 cm). Mesh size was 10 × 15 cm in five, 20 × 15 cm in seven, and 25 cm× 20 cm in three patients. All patients were discharged without complications on the second postoperative day. Mean follow-up was at 12 months. One patient presented with hernia recurrence 14 months after surgery and four patients presented with self-limited seroma. Conclusion Despite ambiguous guidelines and ongoing debate regarding simultaneous bariatric surgery and ventral hernia repair, the short-term outcomes of this approach appeared promising, provided that patients are carefully selected and receive an individually tailored approach.

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