From the Guidelines
The risk of a hematoma after hernia repair surgery is a significant concern, with reported complication rates varying from 11 to 62.9% 1. Hematomas after hernia surgery are generally not dangerous but require monitoring. A hematoma is a collection of blood outside blood vessels that appears as swelling, bruising, and sometimes pain at the surgical site. Most small hematomas resolve on their own within a few weeks with conservative management including rest, ice application for 15-20 minutes several times daily, and over-the-counter pain medications like acetaminophen or ibuprofen as directed. However, large hematomas or those that continue to grow, cause severe pain, fever, increasing redness, warmth, or drainage from the incision site require immediate medical attention as they may indicate infection or other complications. Some key points to consider:
- Hematomas occur because surgery disrupts blood vessels, allowing blood to leak into surrounding tissues.
- Risk factors include blood-thinning medications, certain medical conditions affecting blood clotting, and surgical technique.
- While most resolve without intervention, severe cases may require drainage by a healthcare provider.
- During recovery, avoid heavy lifting (nothing over 10 pounds) for 4-6 weeks and follow all post-operative instructions to minimize complications. It's worth noting that the study from 1 reported a wide range of complications, including bleeding, and highlighted the importance of surgical approach in minimizing morbidity. In contrast, the study from 1 discussed hemorrhagic complications in a different context, but its findings on the timing of surgery after a hemorrhagic event are not directly applicable to hernia repair surgery. Therefore, the most relevant and recent evidence from 1 should guide clinical decision-making regarding the risk of hematoma after hernia repair surgery.
From the Research
Risk of Hematoma after Hernia Repair Surgery
- The risk of hematoma after hernia repair surgery is a potential complication that can occur, as reported in a case study of life-threatening extra-peritoneal bleeding after open inguinal hernia repair 2.
- Bruising and hematoma are common complications after inguinal hernia repair, but are usually resolved spontaneously 3.
- A study on risk factors for postoperative complications in hernia repair found that wound seroma/hematoma is a relatively high risk complication, with a significant association between BMI and complications, as well as diabetes mellitus 4.
- Mesh migration, a rare but serious complication, can also lead to hematoma and seroma formation after hernia repair 5.
- A study investigating risk factors for postoperative seroma/hematoma after transabdominal preperitoneal patch plasty (TAPP) found that the incidence rate of seroma/hematoma was 16%, with internal inguinal hernia and hernia size ≥ 3 cm considered risk factors 6.
Types of Hematoma
- Extra-peritoneal bleeding, as reported in a case study of life-threatening bleeding after open inguinal hernia repair 2.
- Retroperitoneal bleeding, as reported in the same case study 2.
- Wound hematoma, as mentioned in a study on postoperative complications after inguinal hernia repair 3.
- Seroma/hematoma formation, as investigated in a study on risk factors for postoperative complications after TAPP 6.
Prevention and Management
- Detailed knowledge of anatomy and careful dissection are required to avoid complications such as hematoma 2.
- Prompt surgical response with damage control can be a life-saving maneuver in cases of life-threatening bleeding 2.
- Contrast CT can provide valuable information about the location and size of hematoma and guide the operative approach 2.