title: Are routine ultrasound examinations helpful in the detection of bleeding complications following laparoscopic inguinal hernia repair?
abstract: OBJECTIVE
  Intraabdominal bleeding is a dreaded complication after laparoscopic transabdominal preperitoneal inguinal hernia repairs. Routine postoperative sonographic (US) examination and hemoglobin measurement have been suggested to identify bleeding after surgery. We retrospectively assessed the value of these tests.
  
  
  METHODS
  A total of 995 consecutive patients admitted for laparoscopic inguinal hernia repair to a single teaching hospital were analyzed. US examinations were performed postoperatively on the operative day to identify intraabdominal bleeding. In addition, hemoglobin measurements were obtained on the first postoperative day.
  
  
  RESULTS
  Postoperative US examinations were performed on 971 patients (97.6%). Of these, 945 were examined within 24 hours of surgery. Reoperation was necessary in 1.1% (11/995) of the patients because of a persistent seroma in five cases, intraabdominal or inguinal bleeding or hematomas in five cases, and a trocar hernia in one case. In none of the 11 patients requiring reoperation did US examination or hemoglobin measurement indicate acute bleeding or hematoma.
  
  
  CONCLUSIONS
  Routine postoperative US examination and hemoglobin measurement within the first 24 hours of surgery are not suitable for identifying patients with intraabdominal bleeding who require a reoperation. Instead, US examination and hemoglobin measurement should be part of the patient workup when there is a clinical suspicion of a postoperative complication. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:145-149, 2017.
authors.affiliation: Marienhospital Stuttgart, Department of Visceral, General and Thoracic Surgery, Stuttgart, Germany.
authors.forename: Julius
authors.identifier: http://orcid.org/0000-0002-5695-5442
authors.initials: J
authors.lastname: Pochhammer
authors.affiliation: Marienhospital Stuttgart, Department of Visceral, General and Thoracic Surgery, Stuttgart, Germany.
authors.forename: Stefanie
authors.initials: S
authors.lastname: Lang
authors.affiliation: Marienhospital Stuttgart, Department of Visceral, General and Thoracic Surgery, Stuttgart, Germany.
authors.forename: Bettina
authors.initials: B
authors.lastname: Scuffi
authors.affiliation: Marienhospital Stuttgart, Department of Visceral, General and Thoracic Surgery, Stuttgart, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Schäffer
authors.affiliation: Diakonissenkrankenhaus Stuttgart, Department of Endocrine Surgery, Stuttgart, Germany.
authors.forename: Constantin A
authors.initials: CA
authors.lastname: Smaxwil
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging*; D012086:Reoperation; D012189:Retrospective Studies; D014463:Ultrasonography / Q000379:methods*; D055815:Young Adult
keywords: bleeding; complication; laparoscopic hernia repair; sonographic examination