Seroma After Inguinal Hernia Repair
A 60-year-old man underwent laparoscopic inguinal hernia repair five days ago and now notices groin swelling. The swelling is fluctuant and mildly tender, with no erythema, warmth, bruising, or cough impulse. Temperature is 37.2 °C, heart rate 80 beats/min, blood pressure 135/80 mm Hg. Which of the following is the most likely diagnosis?
- A.Superficial wound infection
- B.Postoperative seromaCorrect
- C.Wound haematoma
- D.Early hernia recurrence
Explanation
A seroma is a sterile collection of serous fluid that accumulates in the potential space left after the hernia sac is reduced and the mesh is placed, and it is one of the commonest early findings after laparoscopic inguinal hernia repair. Two negative findings drive the diagnosis here. The absence of erythema, warmth, and fever essentially excludes infection, which would produce local inflammatory signs and systemic upset within this timeframe. The absence of a cough impulse excludes a recurrent hernia, because a recurrence communicates with the peritoneal cavity and therefore transmits a palpable impulse on coughing and is usually reducible. That leaves a fluid collection, either blood or serum. A haematoma typically appears earlier, is more painful, is firmer, and is accompanied by visible bruising or ecchymosis tracking into the scrotum or thigh. A soft, fluctuant, only mildly tender swelling without discolouration is the classic seroma. Management is expectant, because most resolve spontaneously over four to six weeks. Aspiration is generally avoided since it introduces infection into a prosthetic field and the fluid usually reaccumulates.
Why each option
- A.
- Infection would show erythema, warmth, marked tenderness, and fever, none of which are present.
- B.
- Correct. A mildly tender, fluctuant, non-inflamed swelling without bruising or cough impulse a few days after mesh repair is the textbook seroma.
- C.
- A haematoma appears earlier, is firmer and more painful, and is almost always accompanied by ecchymosis of the groin or scrotum.
- D.
- Recurrence would produce a swelling with a cough impulse and variable reducibility, and is very unusual within five days of repair.
Reference: UpToDate 2025, Complications of inguinal hernia repair; HerniaSurge Group International Guidelines for Groin Hernia Management, 2018
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