DOI: https://doi.org/10.53350/pjmhs20221611531 ORIGINAL ARTICLE P J M H S Vol. 16, No. 11, November, 2022 531 Peri-Operative Use of Transexamic Acid in Reduction of Post Operative Seroma Formation in Patients Undergoing Ventral Hernia Repair FARAH BATOOL SIDDIQUI 1 , FAROOQ UMER 2 , TAHA JUNAID 3 , MUHAMMAD AMEER HAMZA 4 , MUHAMMAD MAAZULLAH KHAN 5 , SYED TAHIR RASOOL SHAH 6 1 FCPS Resident General Surgery R4, Jinnah Medical College Hospital, Korangi Karachi 2 HOD and Consultant General Surgery Department, Jinnah Medical College Hospital Korangi Karachi 3 Associate Professor and Consultant General Surgery Department, Jinnah Medical College Hospital Korangi Karachi 4 FCPS Resident General Surgery R2, Jinnah Medical College Hospital Korangi Karachi 5 Fcps Resident General Surgery R2, Jinnah Medical College Hospital Korangi Karachi 6 FCPS Resident General Surgery R1, Jinnah Medical College Hospital Korangi Karachi Correspondence to: Farah Batool Siddiqui, Email:farahbatool9@yahoo.com, Cell: +923062244128 ABSTRACT Objective: To examine the efficacy of Intraoperative and postoperative IV transamine, in reducing postoperative seroma formation in patients undergoing ventral hernia repair. Study Design: Randomized controlled clinical trial Study place: Karachi Methodology: Eighty patients filled out the in-depth age, gender, and body mass index (BMI) registration forms. All of the patients ranged in age from fifteen to sixty. Patients were randomly assigned to either Group A (receiving 1 g of tranexamic acid Intraoperative and 500mg tranexamic acid 12 hours apart daily for 2 postoperative days) or Group B (not receiving any drug during or after surgery). Drainage volume was collected at postoperative day 1, 2, 3, 4, and 5 was recorded and were compared in both groups. Results: The Mean±S.D of age of the participants in both groups were 41.5± 9.9 and 42.75±9.7 years. Group A had 20% males and 80% female, while group B had 22% males and 78% females. The Mean±S.D of BMI of the participants in both groups were 26.8±3.4 and 25.3± 4.4kg/m 2 . A significant difference in the drainage volume between group A and B was observed at 1 st (0.025), 2 nd (0.001), 3 rd (0.004) and 4 th (0.003) day were observed. Practical implication: This study will help to determine how tranexamic acid is useful in reducing seroma after hernia repair Conclusion: Seroma development after ventral hernia surgeries may be minimized with the use of tranexamic acid. Keywords: Hernia, tranexamic acid, clinical trial, seroma, effectiveness, hernia repair INTRODUCTION Worldwide, ventral hernias are common problem for general surgeons. Hernioplasty, which may be performed open or laparoscopically, is now the most prevalent procedure utilized in the literature for ventral hernia repair, while there are others 1 . Prolene mesh is the most popular kind of mesh used in hernioplasty because it reduces the risk of a recurrence 2 . Hernias in the abdominal wall may cause organs like the intestines or omentum to protrude out from the abdomen. This condition is known as an abdominal hernia. These hernias may occur anywhere in the torso, from the thorn to the hips 3 . Operative practice is the typical approach for hernia repair. Patients undergoing significant surgeries, such as abdominal hernia mesh repair, are at a higher risk of developing seromas. Additional risk factors include the patient's age, the number of dissected tissues, the use of anticoagulants, the patient's history of surgery, and the presence of a seroma 4 . After a paraumbilical hernioplasty, fluid collection, a seroma may form as a result of a buildup of serum fluids in the surrounding blood and lymphatic vessels. Cells are frequently seen in the fluid, which is normally transparent. There is speculation that seroma development is linked to an increase in infection and surgical site disturbance. Surgical drain tubes are used after various operations to prevent the development of seroma. They make it possible to regulate the amount of fluid leaking out, and the drainage is emptied once it becomes negligible. When drains aren't utilized and then later removed, seromas might form in the surgical site 5 . Any time fluid collects after surgery, we call it a seroma. Serum is the fluid that forms when blood vessels and lymphatics are injured and begin to leak. Risks of infection and surgical repair failure are often linked to seroma development. Typically, they are removed using suction drains. A buildup in the sealed compartment may be monitored with the help of these drains. When mesh is utilized for abdominal hernia repair, seroma development occurs in 5.6% to 42% of patients in the postoperative period 6 . Surgical sites often develop seromas, which manifest as soft, swollen areas under the skin. The fluid might be colorless or slightly yellow. Infected seromas may cause the discharge to turn from clear to bloody or purulent. When the collection is small, conservative therapy is usually sufficient, but when it's bigger, needle aspiration or, in rare cases, open drainage may be necessary 7 . Fluid accumulation occurs when mesh is used to repair a hernia. However, the risk of seroma development and related consequences increases with the size of the region repaired by mesh. By using tranexamic acid, seroma development may be avoided 8, 9 . Synthetically derived from the amino acid lysine, tranexamic acid has an anti-fibrinolytic effect that may be used to treat and prevent excessive bleeding throughout the initial and secondary phases of wound healing 10 . However well bleeding control measures are implemented, surgical bleeding may still occur if fibrinolysis is greater than coagulation. Fibrinolysis may be prevented by administering tranexamic acid. The conversion of plasminogen to plasmin is inhibited. As much as 34% less postoperative bleeding may be expected while using it. In most research, TXA has been recommended either as an injectable or orally administered drug to lessen the risk of problems after inguinal hernia surgery. We decided to conduct a randomized controlled experiment to learn more about the effects of topical TXA administration on hernia problems because of the contradictory findings of studies and the severe constraints of clinical trials. The purpose of the present study was to examine the efficacy of Intraoperative and postoperative IV transamine, in reducing postoperative seroma formation in patients undergoing ventral hernia repair. METHODOLOGY This randomized controlled clinical trial was conducted at Surgery Department of Jinnah Medical College Hospital, Korangi Karachi from 15 June 2022 to 20 September 2022. A total of 80 patients were recruited randomly of both genders, between age 15-60 years, scheduled have a ventral hernia surgery. The patients' full demographic information, including age, sex, and body mass index (BMI), was collected after obtaining written permission from each individual. Patients with history of taking anticoagulants, obstructed and strangulated hernia patients, uncontrolled diabetes, any personal or family history of thrombotic disease, patients having vascular disease, patients having BMI more than 35 were excluded