Triple-Action Seroma Prevention Protocol in Subcutaneous Onlay Endoscopic Repair.

Background and Objectives: Postoperative seroma is a common surgical site occurrence following procedures that create large subcutaneous dead spaces. This case series describes a triple-action seroma prevention protocol used during subcutaneous onlay endoscopic repair and reports early postoperative outcomes. Methods: We retrospectively reviewed 36 consecutive adults who underwent modified subcutaneous onlay laparoscopic abdominal wall reconstruction for rectus diastasis and midline hernias, with or without postoperative incisional hernia, between March 2024 and December 2025. The protocol combined progressive-tension quilting sutures, irrigation with 20 mL of 12% hypertonic saline retained for 10 minutes, and fibrin sealant application. Closed-suction drains and an abdominal binder were used routinely. Results: Seroma was recorded in 2 of 36 patients (5.6%). Among 15 patients with postoperative incisional hernia and rectus diastasis, seroma occurred in 1 patient (6.7%). Both affected patients were men with obesity and dense subcutaneous fibrosis. Drain output decreased to approximately 20 mL within 10 hours, and drains were removed on postoperative day 1 in all but 1 patient. No infection, mesh infection, skin necrosis, flap ischemia, hypernatremia, or fibrin sealant-related anaphylaxis was recorded. One additional small fluid collection detected at 6 weeks was managed conservatively. Conclusion: In this descriptive series of subcutaneous onlay endoscopic repair, the triple-action seroma Prevention protocol was associated with a low observed seroma rate and early drain removal. These findings are preliminary and require confirmation in larger prospective controlled studies.