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Title: The Effect of Intravenous Tranexamic Acid on Reduction of Seroma After Para-Umbilical Mesh Hernioplasty
Authors: Usman Ali Rahman, Khalil Ahmed, Iftikhar Ahmed, Muhammad Atif Niaz, Muhammad Mohsin, Zain Himayoun
Journal: Journal of Islamabad Medical and Dental College (JIMDC)
Publisher: Healers Educational Society
Country: Pakistan
Year: 2024
Volume: 13
Issue: 1
Language: English
Keywords: Praumbilical herniaSeromaTranexamic acid
Background
Paraumbilical hernia is the second most common presentation in adults. It is managed surgically. Surgical management depends upon the size of the defect. Sizes of more than 2cm are surgically managed by placement of mesh after primary closure of defect. Mesh can be onlay, sublay or inlay depending upon its placement at different anatomic sites of anterior abdominal wall. Seroma formation is one of the major complication of mesh hernioplasty. Different methods are used for prevention of seroma post operatively. These methods include drain placement, proper fascial closure, fibrin glue and use of sclerosing agents. Tranexamic acid can be used for prevention of seroma formation after mesh hernioplasty.
Patients and Methods
It was a case control trail conducted in department of general surgery Gulab Devi Hospital Lahore. In our study 40 patients were included through randomized sampling having paraumbilical hernia undergoing mesh hernioplasty. These patients were divided in two groups. In group 1 patient received Injection Tranexamic acid 1gm pre operatively while in group 2 inj tranexamic acid was not given.
Results
Seroma formation after drain removal was seen in 04(10%) patients only. Out of these 04 patients 01(25%) patient belonged to group 1 while 03(75%) patient were in group 2 which was proved statistically (p-value 0.004). Patients with increased BMI had seroma (26.7 ± 2.1 kg/m2 vs 25.7 ± 1.8 kg/m2) but it was not statically proved (p-value 0.84). Patients with seroma had mean weight of 89 ± 10.7 kg while patients with no seroma had mean weight of 74 ± 11.5 kg which was statistically proved (p-value 0.018).
Conclusion
Injection tranexamic acid 1gm given pre operatively significantly reduces seroma formation as incidence of seroma formation was higher in group 2 as compared to group 1 patients.
To determine the effect of tranexamic acid in seroma formation in patients undergoing para-umbilical mesh hernioplasty.
A case-control trial conducted at Gulab Devi Hospital, Lahore, involving 40 patients with paraumbilical hernia undergoing mesh hernioplasty. Patients were randomly divided into two groups: Group 1 received 1gm of intravenous tranexamic acid pre-operatively, while Group 2 did not receive tranexamic acid. Data collected included post-operative drain output, drain removal day, hospital stay, and seroma formation. Statistical analysis was performed using SPSS 23.0.
graph TD;
A["Recruit 40 patients with paraumbilical hernia"] --> B["Randomly divide into 2 groups"];
B --> C["Group 1: Administer 1gm Tranexamic Acid IV pre-op"];
B --> D["Group 2: No Tranexamic Acid"];
C --> E["Perform Mesh Hernioplasty"];
D --> E;
E --> F["Monitor Drain Output, Drain Removal, Hospital Stay"];
E --> G["Assess Seroma Formation Post-Drain Removal"];
F --> H["Collect and Analyze Data"];
G --> H;
H --> I["Statistical Analysis SPSS 23.0"];
I --> J["Draw Conclusions"];
Para-umbilical hernia defects larger than 2cm are typically managed with mesh hernioplasty, a procedure prone to seroma formation, which can lead to complications like infection and increased hospitalization. The study's findings suggest that pre-operative intravenous tranexamic acid reduces seroma incidence, aligning with some national and international studies. The drug's antifibrinolytic properties may contribute to preserving fibrin matrix structure. Earlier drain removal and reduced drain output in the tranexamic acid group also suggest a benefit. Obesity is identified as another risk factor for seroma formation. The authors recommend further multicenter studies with larger sample sizes to solidify these findings.
Seroma formation was observed in 4 (10%) patients post-drain removal. Of these, 1 (25%) patient was in the tranexamic acid group (Group 1) and 3 (75%) were in the control group (Group 2), a statistically significant difference (p-value 0.004). Patients with higher BMI and weight were more likely to develop seroma, with weight being statistically significant (p-value 0.018). Drains were removed earlier in the tranexamic acid group, and drain output was lower.
Intravenous tranexamic acid administered pre-operatively appears to reduce the incidence of seroma formation after para-umbilical mesh hernioplasty. This intervention may also lead to earlier drain removal and reduced hospital stay, contributing to decreased patient morbidity and healthcare costs.
* 40 patients were included in the study. (Confirmed in Methodology and Results)
* Seroma formation was seen in 4 (10%) patients. (Confirmed in Results)
* The p-value for the difference in seroma formation between groups was 0.004. (Confirmed in Results)
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