Laparoscopic Mesh-Salvage Fenestration for Chronic Symptomatic Seroma after Rives-Stoppa Incisional Hernia Repair: A Case Report.

introductionChronic encapsulated seroma after retromuscular incisional hernia repair can be difficult to manage, particularly in symptomatic patients without evidence of mesh infection. Open anterior capsulectomy may require wide mesh exposure and carries potential risks of mesh infection and recurrent incisional hernia. Herein, I report a case of a chronic symptomatic seroma successfully managed by laparoscopic mesh-salvage fenestration. CASE PRESENTATION: A 58-year-old man developed a chronic symptomatic seroma after open Rives-Stoppa repair for a midline incisional hernia. CT demonstrated an encapsulated fluid collection measuring approximately 10 × 7 cm dorsal to the rectus muscles, without signs of mesh infection. Because the symptoms persisted for 9 months despite repeated aspirations, laparoscopic fenestration through the posterior rectus sheath and retromuscular mesh was performed. Six fenestration openings were created to establish controlled communication between the seroma cavity and the peritoneal cavity. Percutaneous transfascial sutures were placed adjacent to the relatively larger defect to promote cavity collapse and reduce the potential risk of bowel incarceration. The postoperative course was uneventful. Follow-up MRI demonstrated substantial shrinkage of the chronic seroma cavity, with a small amount of asymptomatic omental protrusion through the mesh defect. Marked improvement in symptoms and QOL scores was observed after surgery.

conclusionsLaparoscopic fenestration through the posterior rectus sheath and retromuscular mesh may be a feasible, minimally invasive mesh-salvage option for selected patients with chronic symptomatic seroma after retromuscular incisional hernia repair in the absence of mesh infection.