Seroma?

[ajm222]

So my surgery two days ago generally went very well, but I have a large bulge that looks like the original hernia if not a bit bigger. It’s where the incision is and is suspected to be a possible seroma. The area isn’t black and blue or anything so I don’t think it’s a hematoma.

Anyway, I know sometimes this happens after surgery and more often than not apparently eventually subsides and the fluid reabsorbs. And based on my previous surgeries, I wouldn’t be surprised if I had a lot of fluid collection. I felt pretty bad for a few days after mesh removal because I felt my whole torso was swollen.

Any experience with post surgical seroma? Mine was an open tissue repair for inguinal hernia.

[LD50]

ajm222 In 2019 I had an open tissue repair of a very large incisional hernia. A seroma formed soon after the surgery and became very large. Though I never met with the surgeon again in person, I sent photos of the area while I was laying supine and he thought it was softball sized, but I think it was closer to soccer ball- really huge. I had US imaging done several times since to follow it. US showed that it transformed into a hematoma and back again (no indication of black/blue on my skin when it was a hematoma, since the seroma itself is deeper than skin level).

The surgeon didn’t want to drain it because apparently draining increases the risk of infection and most seromas resolve on their own within a couple weeks/months. Also, I became much less motivated to travel to the surgeon or go to a local doctor or hospital for treatment due to the pandemic lockdown which started a few months after my surgery. My seroma may have lingered as long as it has (the imaging center where I have had all of the imaging done on the seroma says the remainders of the seroma are still present) because shortly post-op, I did manual therapy on my abdomen to relieve the pain and I received a session of acupuncture on my abdomen specifically in the area of the seroma. US showed that the seroma transformed into a hematoma shortly after I started a Chinese herbal formula (Jin Gu Die Da) that is supposed to mend bruises by bringing blood to the bruised area. US showed the hematoma transformed back to a seroma over a couple months after I stopped taking that formula.

Incidentally, prior to the operation, the surgeon had advised against post-op abdominal massage and acupuncture. We can learn from this that being a non-compliant patient has real risks, don’t do manual therapy or have acupuncture on the seroma area itself and that from a Traditional Chinese Medicine perspective, seromas aren’t bruises.

Also, many years ago I had a small seroma from a previous abdominal surgery which ruptured about a week post-op. The doctor gave me a couple rounds of antibiotics to treat any infection and the area healed rapidly. Apparently some people are prone to seromas, so now that you know your body forms seromas, make certain to inform any other surgeon you may need in the future that you had a seroma.

[ajm222]

Thanks! That’s very helpful. I can’t believe it was that large and that you lived with that for a while. That’s crazy. So did it eventually totally go away in the sense that you couldn’t outwardly tell you’d had that large of a seroma/hematoma? Was the skin loose? All fine now?

I did come across another post here from someone with a Shouldice repair that developed a large seroma and it took a little over a month and they were very concerned (not surprising as it looks and sometimes feels like another hernia) but it went away and they totally healed. I’m only about 3 1/2 days out but obviously I catastrophize and overthink stuff. And I’ve had nothing but time to sit around and worry for several days. I also think the anesthesia gives me extra anxiety and depression for a while, and recovering from surgery in and of itself is stressful.

Thanks again for the feedback.

[Watchful]

I was told by a robotic mesh surgeon that seroma was the most common complication, and that it goes away on its own.

What kind of anesthesia did you have? General, or local with sedation?

[ajm222]

I think that’s true. Mine was general.

[ajm222]

What’s weird though is that ‘edema’ is also normal and common and seems almost the same, but treatment is opposite. Seroma – rest and heat. Edema – cold and activity. What’s a patient supposed to do with that, especially when there’s no real obvious way initially to tell which is which?

[LD50]

While I believe there are remnants of my seroma on US, I don’t notice anything that I can point to that indicates whether or not I currently have a seroma.

I do have a very different situation than you do. I have loose skin from weight loss. I have a large ventral hernia and a rectus diastasis, so everything looks abnormal, but I don’t think it looks abnormal from the seroma.

I think that if you follow your surgeon’s instructions (i.e. don’t be a non-compliant idiot like I was), your seroma will resolve uneventfully. I know it’s difficult to wait and see, but I don’t know of an alternative.

[ajm222]

Thanks again. Seems others had a similar experience and saw relief after several weeks. It’s hard to imagine walking around with this thing for another month or two but if the long term picture is good, I’ll survive. Shouldice and other experts seem to suggest that just waiting for the body to reabsorb them is best as draining them is risking infection.

My biggest worry is that it might somehow compromise the repair, but it doesn’t seem like that typically happens for whatever reason. Maybe it even puts some useful pressure on the stitches, keeping them secure. Ha, probably not.

I’ve been regularly using a heating pad per doctor’s instructions and keeping up with the pain meds for their anti-inflammatory impact. I also probably need to start moving around more. The pressure at night sometimes makes things uncomfortable and difficult to sleep, but otherwise it’s mostly just an annoyance.

[Watchful]

Have you been able to find out what repair technique he used?

[ajm222]

I have the operative report but don’t have any way of knowing what technique was used because I don’t under all the details. He didn’t mention a specific branded repair. In fact prior to surgery he kind of suggested that these repairs all have some similarities and not to get too caught up in the branding and that he would do what was necessary to fix once he saw the situation and condition of the tissue. I’m sure whatever he did was most similar to one of the major types of repairs but I just don’t know which. I will likely ask him when I go for my follow up in a month.

[ajm222]

And for anyone with a seroma or lots of swelling, was it really uncomfortable for you walking around until it started getting smaller? Having a large and firm lump in your groin is not the most comfortable thing I’m finding, even in the absence of pain (though today, after a nice night of almost zero discomfort while lying down, I have quite a bit more soreness today in that area – always seems to be how it works – two steps forward and one step back).

[LD50]

Both of my seromas were very painful which is why I (ill-advisedly) sought out relief for the 2nd one using manual therapy and acupuncture. I think acupuncture would have been helpful if I insisted that there was no needlework on my abdomen (open incisional hernia tissue repair). The first seroma I had (after C-sect) was very painful until it ruptured.
I am scheduled for a robotic mesh repair of my recurrent ventral hernia on March 3 and I anticipate a seroma. I’m anticipating that there will be a lot of pain until the seroma resolves. I have a high pain tolerance and I don’t want to use narcotics (or really much of any pharmaceuticals) for pain relief, but I’m keeping an open mind. I do plan to receive acupuncture to facilitate healing/ reduce pain and my current acupuncturist and I are on the same page re:no abdominal needlework. I’m hopeful that this will be my final hernia repair, so I plan to follow my surgeon’s instructions and I’ll be glad when this entire episode is in the past.

[ajm222]

That makes me feel a little better. Mine isn’t painful really. Just obviously hinders movement. And after everything I’ve been through, I’m super sensitive to even the slightest sensation. So moving around with this lump pulling on things and pushing against things is just disconcerting. I think it does also cause a little discomfort or soreness because of the pressure, but not much.

Hope you’re next surgery goes smoothly! I am also hoping this is my last surgery for a long time. But at this point I’m not placing any bets.

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