One discussion this week included the impact of abdominal binder on seroma formation.
Reference: Christoffersen MW, Olsen BH, Rosenberg J, Bisgaard T. Randomized clinical trial on the postoperative use of an abdominal binder after laparoscopic umbilical and epigastric hernia repair. Hernia. 2015 Feb;19(1):147-153. doi:10.1007/s10029-014-1289-6
Summary: Application of an abdominal binder is often part of a standard postoperative regimen after ventral hernia repair to reduce pain and seroma formation. However, there is lack of evidence of the clinical effects.
METHODS: Patients were randomized to abdominal binders vs. no abdominal binders during the first postoperative week. Standardized surgical technique, anaesthesia, and analgesic regimens were used and study observers were blinded towards the intervention. Postoperative pain (visual analogue score) on day 1 was the primary outcome. In addition, ultrasonographic evaluation of seroma formation and several subjective patient-related parameters were registered. Furthermore, patients in the abdominal binder group were asked to rate benefits or discomforts of wearing the binder.
Seroma formation was estimated by a transabdominal ultrasonography scan performed by an expert radiologist, who was blinded towards intervention. Seroma was defined as a fluid collection in relation to the previous hernia sac or in relation to the mesh. The seroma was quantified in ml. In case of more than one fluid collection, individual collections were summed.
RESULTS: From October 2012 – September 2013, 60 patients were randomized and 56 completed the study (abdominal binder, n = 28; no binder, n = 28). No significant intergroup differences in postoperative pain or any of the other surgical outcomes, including seroma formation, were found. However, the abdominal binder group reported subjective beneficial effect of wearing the binder in 24 of the 28 patients (86%). No adverse effects of the abdominal binder were found.
In the abdominal binder group, 27/28 patients had seroma formation on day 7 compared with 26/28 patients in the no binder group (P = 0.611). The median volume of seroma was 7 ml (range 0–301) in the abdominal binder group and 9 ml (0–164) in the no binder group (P = 0.688)
CONCLUSION: There were no effects of an abdominal binder on pain, movement limitation, fatigue, seroma formation, general well-being, or quality of life. However, most patients claimed a subjective beneficial effect of using their abdominal binder. The authors suggest “a postoperative abdominal binder could be considered after repairs for small ventral hernias” (p.152).