A Novel Approach to Inguinal Seroma after Minimally Invasive Mitral Valve Surgery

Objectives: Major benefits of minimally invasive mitral valve surgery are the consistent finding of faster rate of recovery, reduction of pain and the speedy return to normal activity. Even in the hands of experienced surgeons the incidence of inguinal seroma is reported to be 2 to 11.3%. In our institution, seroma after minimally invasive mitral valve surgery has an occurrence rate of 2.7%. We have adopted the technique of tapping the seroma and applying a continued closed suction drainage and patients can proceed to rehabilitation.

Methods: The seroma is identified with palpation and with ultrasound. The lymphocele is tapped to identify the localization and inspect the fluid that needs to be evacuated. Then a suction catheter is inserted into the cavity and is advanced into the lymphocele which tends to be seated superficially. Usually an amber colored lymphatic fluid starts to flow, indicating that the catheter has been safely placed. The catheter is then connected to a closed suction drainage with a vacuum flask. The deflation of the cavity is immediate.

Result: A total of 39 patients in our institution noticed and reported an inguinal bulge with a certain interval to the minimally invasive operation; the minimum being 6 days and the longest was over a year after the initial operation, on average on the 34.4 postoperative days. In three patients (7.7%) the drain had to be reinserted a second time; one had to be removed because of pain and needed a second insertion, for another the suction catheter was clogged, for the third patient the drain was removed too early and had to be reinstituted. Only one patient needed an additional single aspiration after the drainage was removed (2.6%). After 14.9 days on average, the drainage was removed. All patients were successfully treated with this method. None of these patients needed additional surgery.

Conclusion: The preferred cannulation sites for minimally invasive surgery are the groin vessels. In preparation of the vessel exposure, the practically invisible lymphatic vessels are disrupted and the run off is discontinued, this accumulates in the created space, identifiable as a swelling which proves to be uncomfortable for the patient and requires intervention. Our experience with applying local pressure or decompressing the bulge with aspiration had been unsatisfactory and we have adopted the technique of evacuating the fluid with prolonged closed suction drainage. Patients can stay mobile and participate in rehabilitation procedures. Another option we have adopted to minimize inguinal effusion is to cannulate the groin vessels through percutaneous puncture and with the use of a vessel closing device.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
19 February 2021