Incidence Of Seroma Formation Research Articles

A randomized study on laparoscopic total extraperitoneal inguinal hernia repair with hernia sac transection vs complete sac reduction.

The management of the hernia sac is the core step of laparoscopic indirect inguinal hernioplasty. In this study, a randomized controlled trial was conducted to evaluate the clinical effect of laparoscopic total extraperitoneal inguinal herniorrhaphy (TEP) with hernia sac transection and complete sac reduction. From May 2017 to May 2018, 70 patients aged 18-75 with primary indirect inguinal hernia in our hospital were randomly divided into a transected sac group (TS) and a completely reduced sac group (RS). The primary outcomes compared between the two groups were the hernia sac treatment time, operation time, and the incidence of seroma formation after operation. Secondary outcomes included acute pain, chronic pain (pain which lasted for at least 3months), hospital stay, recurrence rate, and other complications. There were no significant differences in baseline demographic characteristics including age, sex, hernia type, size of hernia defect, and follow-up time between the two groups. The times required for hernia sac separation and operation in the TS group were significantly shorter than in the control group (6.1 ± 2.3 vs. 25 ± 5.8min for hernia sac separation, p < 0.01; and 35.10 ± 3.50 vs. 54.40 ± 4.20min for operation, p < 0.01). There was no significant difference in hospitalization time, incidence of acute pain, seroma formation, or urinary retention between the two groups. During the 12-month follow-up period, chronic pain, early recurrence, and other complications were not found in either group. Both the hernia sac transection technique and the complete sac reduction technique are safe and reliable. The hernia sac transection technique is a simple and effective hernia sac treatment method. It reduces the operation time and does not increase seroma or acute or chronic pain. It is valuable and likely to be popularly applied.

Effect of subcutaneous closure technique on incisional complications and postoperative pain in cats undergoing midline celiotomy: A randomized, blinded, controlled trial.

To compare the effect of three methods of subcutaneous tissue closure on postoperative incisional complications and pain in cats. Single-center, randomized, blinded, controlled trial conducted in a veterinary teaching hospital. Two hundred ninety-seven cats undergoing midline celiotomy for ovariohysterectomy (n = 280) or other abdominal procedure (n = 17). Cats (n = 297) were assigned to one of three subcutaneous closure methods: simple continuous apposition with tacking to the rectus fascia (n = 108, quilting [Q] group); simple continuous apposition (SC; n = 94); no subcutaneous closure (NC; n = 95). Primary outcomes were incidence of seroma formation, postoperative pain, and surgical site infection or dehiscence. Active follow-up was obtained at 10 and 30 days postoperatively. Baseline characteristics did not differ between groups. Seroma was less common in the Q group (13.0%) than in the NC (27.3%) and SC (25.9%) groups (P = .03). Compared with the other two groups, the relative risk of seroma formation in the Q group was 0.49 (95% CI = 0.28-0.86, P = .01). Median mechanical pain thresholds were higher (indicating greater comfort) in cats with subcutaneous sutures (Q and SC = 1.23 [interquartile range (IQR), 0.2-2.6 N], NC = 0.83 [IQR, 0-1.87 N], P = .04) on the day after surgery. Closing subcutaneous tissues with a quilting closure pattern reduced seroma formation in cats undergoing celiotomy. Placing a quilting suture pattern in the subcutaneous tissues after celiotomy is a simple low-cost measure that reduces seromas in cats. Abstaining from subcutaneous closure cannot be recommended because of increased seroma formation and pain.

Abdominoplasty, seroma formation and duration of hospitalisation: comparative analysis and outcome of 112 consecutive lipoabdominoplasties performed using progressive tension sutures

There are conflicting reports that early mobilisation and outpatient-based surgery is associated with higher prevalence of seroma formation. Current comparative retrospective study was carried out to establish whether ambulatory surgery and early mobilisation has an impact on any higher incidence of seroma formation. A retrospective analysis of 112 cases of consecutive lipoabdominoplasties with progressive tension sutures was carried out. Patients were divided into groups A, B and C. Group A included 27 patients and were operated as ambulatory cases, with mean age of 36.1 ± 6.98 years and mean BMI of 23.8 ± 3.02. Mean tissue excised was 592 ± 373 g, mean volume of lipoaspirate to abdomen was 352 cc ± 158 and mean 1st 24-h drainage was 26.9 ± 17.24 cc. No patient had seroma. Group B included 68 patients who stayed one night with a mean age of 40.6 ± 11.36 years, mean BMI of 27.4 ± 5.34, tissue excised was 863 ± 544 g, mean volume of lipoaspirate to abdomen was 649 cc ± 510 and mean 1st 24-h drainage was 52.1 ± 58.8 cc. No patient had seroma. Group C included 17 patients who stayed in for two nights as inpatients. Mean age was 38.8 ± 9.66 years, mean body mass index (BMI) of 27.0 ± 4.06. Tissue excised was 927 ± 434 g, mean volume of lipoaspirate was 563 cc ± 316. Mean 1st and 2nd 24-h drainage was 80.1 ± 44.55 cc and 64.8 ± 42.4 cc respectively. No patient had seroma. Based on the study design, it is possible to conclude that early ambulation most likely did not contribute to seroma formation diagnosed by clinical examination alone in this series. Level of Evidence IV. Risk/prognostic study.

Comparative Study between Outcomes of Abdominoplasty with or without Use of Diuretics in Postoperative Treatment

Background: Seroma formation is a common complication after abdominoplasty and is associated with delayed wound healing, infection, skin flap necrosis, patient discomfort and repeated visits to the outpatient clinic to deal with seroma and its sequelae. Closing the dead space after abdominoplasty seems to be key in reducing seroma and its complications. Objective: The aim of this study was to compare outcome amount of serous fluid in the drain and incidence of seroma post abdominoplasty with and without use of spironolactone in medical treatment in postoperative period. Patients and Methods: This study was conducted on 40 patients who underwent classical abdominoplasty without use of mesh, all laboratory and radiological investigations were done. Patients were divided into two groups group A involved 20 patients who didn't take spironolactone and group B included 20 patients that had taken spironolactone for 15 days postoperative. Results: In group A, there were 3 males and 17 females and mean age was 34 ± 8.6 years. Group B consisted of 5males and 15 females, their mean age was 40 ± 10.8. BMI was 13 patients >25 in group A and in group B was 6 cases >25. There is small paraumbilical hernia in 4 patients in group A and in 3 patients in group B. Group B who took spironolactone showed significant improvement in outcome including volume of fluid in the drain, time of removal of drain and no occurrence of flap edema. Conclusion: There was statistically significant decrease in the incidence of seroma formation after abdominoplasty with the use of spironolactone postoperative.

Shall we use a mesh in every patient undergoing repair surgery for umbilical hernia? a prospective study

Purpose: The aim of this study is to compare the outcomes in patients with umbilical hernia who underwent suture-only repair (primary suture repair and Mayo’s repair) to those with mesh (hernia repair with prolene or the Ventralex Hernia Patch (VHP) hernia repair).Materials and Methods: ASA 1 and ASA 2 patients who had no medical condition requiring surgical intervention other than umbilical hernia were included in this study.. Small hernias were repaired by suturing only while mesh repair was used for medium size and large hernias. Among parameters to be assessed were presence of comorbidities, hernia repair techniques, postoperative complications, and postoperative recurrence rates by repair techniques. Follow-up assessments including physical examinations and/or ultrasound studies were performed to evaluate potential recurrences and other complications. Results: A total of 153 patients were included in the study. The incidence of seroma formation was significantly higher in the prolene mesh group than others. Recurrences occurred in four out of 25 patients who underwent primary repair (16%) and three out of 69 patients who underwent Mayo’s repair (4.3%). Recurrence rates were statistically significantly higher in the primary suture repair group than the other groups. Conclusion: In this study, overall recurrence rate following umbilical hernia repair was found to be 4.57%. Recurrences were not observed in mesh group. Low complication and recurrence rates suggest that this technique may be an appropriate surgical modality to repair umbilical hernias 2 cm or less in size. Umbilical hernia repair with mesh appears to be superior over than tissue-suture repair without mesh.

CLO19-041: Lymphatic Ligation Versus Conventional Axillary Lymph Node Dissection in Breast Cancer Patients: A Randomized Control Trial

Objective: The primary objective was to evaluate seroma formation in a comparison between the lymphatic ligation technique and conventional axillary lymph node dissection. The secondary objective was to evaluate the factors affecting seroma formation. Materials and Methods: A randomized control trial was conducted between January 2014 and November 2017. 68 consecutive patients undergoing mastectomy with axillary lymph node dissection by one experienced surgeon. The patients were randomly sampled and assigned to Group 1 (lymphatic ligation; n=34) and Group 2 (conventional surgery; n=35). Results: 18 patients had developed seroma (26.09%) with 8 (23.53%) patients who were in the lymphatic ligation group and 10 (28.57%) patients who were in the conventional group. No statistical significance was discovered in seroma formation (P=.633), drain duration (P=.238) or total drain volume (P=.330) between the two groups. Longer operative time was statistically and significantly correlated with lymphatic ligation (P=.002). Age, BMI, total drain volume, and drain dislodgement were significant factors influencing seroma formation (P=.005, P=.002, P=.008, P=.015, respectively). Multivariate analysis showed age and BMI were significant factors influencing seroma formation (P=.008, P=.025, respectively). Conclusion: The lymphatic ligation technique could not reduce the incidence of seroma formation. Age, BMI were the factors influencing seroma formation in the patients undergoing mastectomy with axillary lymph node dissection.

Quilting of Mastectomy Flaps; a Simple Way to Avoid Postmastectomy Seroma

Mastectomy is still one of the fundamental options for treatment of breast cancer. Postmastectomy seroma formation is a common complication that can lead to significant morbidity. A lot of studies focused on mechanical obliteration of the postmastectomy dead space assuming it is the primary factor for seroma development. The aim of this study was to evaluate the efficacy of quilting technique in reducing the incidence of postmastectomy seroma. The study included 800 patients who were randomized into two equal groups; A and B, where quilting has been performed to “group B.” The patients were followed up to measure daily drain output with monitoring of seroma formation in the next 14 days after drain removal. “Group B” showed significant reduction in the mean of fluid drained (246.08 ± 78.94 mL) (P < 0.001) compared with “group A” (664.75 ± 69.43 mL) together with significant reduction in incidence of seroma formation with incidence of 21.75% and 3.5% (P < 0.001) for groups A and B, respectively. Quilting is an effective technique in reducing the incidence of postmastectomy seroma formation.

Comparative study between onlay and sublay repair of ventral hernia

Background Ventral hernia is one of the most common surgical operations performed all over the world. Surgical repair is done using prolene mesh and can be placed over anterior rectus sheath (onlay) or in preperitoneal space. However, the debate still continues about the superiority of each technique over the other. Aim To study operative time, easy of procedure, early postoperative complications, duration of hospital stays, recurrences, and outcomes of the onlay versus sublay mesh repair. Patients and methods One hundred patients with paraumbilical, epigastric, and supraumbilical incisional hernias were included in this study and were managed at Al Zahra Hospital. Patients were divided into two main groups: group A underwent onlay mesh repair and group B sublay mesh repair. The patients included were evaluated for operating time, postoperative seroma formation wound infection, drain duration, postoperative hospital stay, and recurrence of symptoms. Results A total of 100 patients were operated in our study: 50 patients were in group A and 50 patients in group B. The mean operative time in group B was 70±18.50 min and in group A was 50±12. The duration of hospital stay was on an average 1–3 days in group B, and average hospital stay was 2–4 days in group A. In the group B, the drain was removed after 2–3 days, and in some patients with small defect, there was no need for putting a drain, but in group A, the drain was removed after 2–5 days, except for one patient with large supraumbilical incisional hernia, where drain was removed after 10 days. Postoperative complications like a seroma and wound infection were comparable in both groups. Conclusion Sublay mesh repair is a better technique with less incidence of seroma formation, a lower rate of postoperative compilations like infection and wound edge necrosis, no recurrence rate, and minimal mesh related-compilations.

Reoperation and Postoperative Outcomes for Single-Stage versus Two-Stage Breast Reconstruction Following Mastectomy: A Meta-Analysis

Introduction Implant based breast reconstructions has become widely accepted as an appropriate reconstruction method following mastectomy for breast cancer. The two most common techniques include immediate reconstruction and implantation (single-stage procedure) or the use of a tissue expander with delayed insertion of implant and reconstruction (two-stage procedure). Using existing studies and available data, a meta-analysis was performed analyzing reoperation rates and postoperative complications between these two methods based upon available literature. Methods A literature search was performed by two individual investigators using the databases PubMed, Cochrane, and Medline. All articles comparing implant based single and two stage breast reconstructions outcomes between 2006 and 2016 were utilized. The primary endpoint of interest was reoperation rates. Secondary endpoints included postoperative complications such as infection, seroma, hematoma, and necrosis. Results A total of five studies met the inclusion criteria, for a total of 12,357 breast reconstructions. 2,281 breast reconstructions were singlestage and 10,076 were two-staged. The primary endpoint of reoperation was increased reoperation rate in the single-stage breast reconstruction (OR=0.78, CI 0.67-0.91; p&lt;0.05). Secondary endpoints demonstrated no statistical significance in infections (OR 1.06, CI 0.84-1.34; p=0.40), hematoma (OR=1.66, CI 0.91-3.05; p=0.09) and necrosis (OR=1.13, CI 0.76-1.68; p=0.29). However, there was an increased incidence of seroma formation in two-stage reconstruction (OR=1.86, CI 1.05-3.28; p&lt;0.005). Conclusions Single and two-staged implant breast reconstructions had similar infection, hematoma, and necrosis rates. Single-stage reconstructions resulted in a significant increase in reoperation/revision rates.

Using quilting sutures in decreasing seroma formation after managing large ventral hernias: a comparative study

The aim of this study was to evaluate using quilting sutures in a prospective randomized controlled manner the decrease in the incidence of seroma formation among patients subjected to ventral hernia repair. The study was a prospective randomized controlled study. 370 patients with large ventral hernias were randomly distributed among two groups. Group A (control group) included 180 patients in whom the repair was done without quilting sutures. Group B (quilting group) included 190 patients, all performed with quilting. Method of dissection was unified as far as possible. All cases had an attached closed suction drain that was removed after two successive days of output ≤ 50cc. The output of the suction drain was recorded; accumulation of clinically detected seroma after 1, 2 and 4weeks of removal of the drain was monitored. There was no statistical difference between both groups as regards the demographic data and the hernia characteristics. There was significantly smaller amount of output of the drains in every day of the first five postoperative days as well as the total amount of the output before drain removal in favor of the quilting group. Drains were removed earlier in group B. The incidence of clinically detected seroma was less in group B as well. Quilting sutures is an effective and easy technique to reduce post-ventral hernia seroma accumulation.

A novel technique of harmonic tissue dissection reduces seroma formation after modified radical mastectomy compared to conventional electrocautery: a single-blind randomized controlled trial

BackgroundSeroma is the most frequent postoperative complication following breast cancer surgery. Our aim was to evaluate the effect of the harmonic focus scalpel versus electrocautery in reducing seroma formation post-mastectomy and axillary clearance.MethodsA prospective randomized controlled trial study was conducted at the Department of Surgery of Suez Canal University Hospital from April 26th 2014 to 30th June 2016. Seventy-two women, in whom a mastectomy and axillary clearance for breast cancer were performed, were randomly allocated to either harmonic dissection (n = 36) or electrocautery (n = 36).ResultsThe mean operative time was significantly longer for harmonic dissection compared with electrocautery (2.63 ± 0.41 vs. 1.75 ± 0.26 h; p < 0.0001). In addition, a significantly smaller amount of intraoperative blood loss (69.4 ± 25.1 vs. 255.5 ± 41.6 ml; p = 0.002) and total drainage volume (1277.8 ± 172.5 ml vs. 3300 ± 167.5 ml; p = 0.002) were found in the harmonic group. Moreover, there was a significant reduction in the time of drain removal (10.9 ± 1.12 vs. 15.9 ± 1.44; p = 0.001) and the incidence of seroma formation after drain removal [8.3% vs 33.3%; p = 0.003] in the harmonic group compared with those in the electrocautery group.ConclusionHarmonic dissection technique leads to significant decreases in intraoperative blood loss, total drainage volume and postoperative seroma in terms of shorter drain duration with a minimal increase in the operative time and better quality of life. Here, we recommend the use of the harmonic dissection technique in mastectomy and axillary clearance.

A comparative study of outcomes of Lichtenstein repair and Desarda tissue repair in patients of inguinal hernia

Background: Inguinal hernia is a very common surgical problem for which, mesh-based techniques, particularly the Lichtenstein repair is considered standard. However, problems like foreign body sensation, wound infection, cord fibrosis, chronic pain and recurrence are major concern. Desarda tissue repair (non-mesh technique), which was given by an Indian surgeon, is now being used in many countries because of low cost of procedure with very low recurrence rates. The objective of this study was to evaluate the feasibility of Desarda tissue repair at a tertiary care centre of Central India as a treatment of primary inguinal hernia, by comparing it with Lichtenstein repair in terms of various post-operative parameters.Methods: Patients between age of 18 and 70 years with primary inguinal hernia were included in this randomised controlled trial. Patients with strangulated, obstructed or recurrent hernia, surgically unfit patients and patients having unmanaged urinary obstruction, cough or constipation were excluded. Randomization was done by sealed envelope method into Lichtenstein and Desarda arm and respective surgeries were performed.Results: 90 patients were included in the study and average duration of follow-up was 15.1 months. Operative time was significantly less in Desarda arm (14.75 min compared to 21.32 min in Lichtenstein arm). Cost, incidence of seroma formation, post-operative pain, foreign body sensation and chronic pain were also significantly less in Desarda arm. No recurrence was observed in both arms.Conclusions: Desarda repair is easy to perform and takes less time to perform and proves cost effective. Desarda repair is comparable to Lichtenstein repair in terms of many parameters and superior in terms of post-operative pain and foreign body sensation and can be preferred for young patients. In infected and strangulated cases, Desarda repair can be used effectively without fear of mesh infection.

English

BACKGROUND: Seroma formation and its sequelae including infection, flap necrosis, delayed wound healing and patient discomfort form one of most commonly encountered complication following mastectomy and axillary dissection. Mechanical closure of dead space by flap fixation is a simple surgical procedure that eliminates dead space after mastectomy, by decreasing the movement of flap over chest wall and thereby reducing the exudate. OBJECTIVE: The objective of this study is to evaluate the effect of mechanical closure of dead space after mastectomy in prevention of seroma formation. METHOD: A total of 80 patients of Carcinoma Breast who underwent Modified Radical Mastectomy in Department of general surgery, Government Rajaji Hospital, Madurai during the period from March 2016 to August 2016, were included in this prospective study, and randomized into two groups based on in-patient number. 42 patients with odd IP no in conventional simple wound closure (Group A) and 38 patients with even IP no in Flap fixation (Group B). Patients were evaluated for day 1 drain volume, total drain volume, drain removal day, seroma, and wound complications. RESULT: Of the 80 women, 42 women with mean age 48±8 years belongs to group A and 38 women with mean age 46±7 years belongs to group B. Average size of the tumor at presentation was 3.4cm. 36 (45%) women presented with stage IIA disease and 44 (55%) with stage IIB disease. Drain volume in first post-operative day varied from 100 to 200ml with average of 170ml in group A and 163ml in group B. There was no statistically significant difference in the drain volume in first post-operative day (p > 0.05). The average total drain volume in the post-operative period in group A was 1426ml and 932ml in group B. p value was found to be significant (< 0.001). The average day of drain removal in group A was 13 days and 8 days in group B. p value was found to be significant (< 0.001). 8 patients developed seroma in Group A Vs none in group B. p value was found to be significant (> 0.05). One patient developed wound complication (cellulitis) Vs none in group B. There was no statistically significant difference in the incidence of wound complications in both groups. CONCLUSION: The present prospective study demonstrated that the mechanical obliteration of dead space by flap fixation significantly decreases the incidence of seroma formation. So when performing modified radical mastectomy, the flap-fixation technique is a valuable technique for reducing seroma formation allowing early drain removal and increased patient satisfaction.

Karydakis Flap With Compressing Tie-over Interrupted Sutures Without Drain versus Standard Karydakis for Treatment of Sacrococcygeal Pilonidal Sinus Disease.

Sacroccygeal pilonidal sinus disease is a worldwide health problem, affecting young adults, mainly males, with a tendency for recurrence. Various modalities have been used for treating this condition. The Karydakis procedure is one of most commonly used asymmetric flaps for treating this condition. The study aimed to evaluate the Karydakis procedure with tie-over compressing sutures instead of the routine use of a drain in the treatment pilonidal sinus. This prospective randomized controlled clinical study was conducted between January 2010 and January 2015. The study was conducted at Minia University Hospital. The study included 154 patients. Patients were randomly assigned into 2 equal groups. The patients in group 1 were operated on by the standard Karydakis procedure, and the patients in group 2 were operated on by the Karydakis procedure with tie-over compressing sutures without a drain. The primary outcomes measured were the incidence of seroma formation, wound complications, length of hospital stay, off-work time, and recurrence rate. All patients were discharged on the same day of surgery in group 2 compared with a mean hospital stay of 4.9 ± 2.4 days in group 1. No patients developed seroma in group 2 compared with 7.8% in group 1. In group 2, 1.3% of patients developed wound infection compared with 9.1% in group 1. The average time for return to work in group 2 was 10.2 ± 1.4 days compared with 12.6 ± 4 days in group 1. No recurrences were noted in group 2 compared with 2.6% in group 1. The feedback about postoperative pain and patient satisfaction about the scar were not investigated. The extent of the disease in both groups was not investigated. The duration of follow-up too short to accurately weight recurrence rate. Karydakis flap with tie-over compressing interrupted sutures without a drain is safe, 1-day surgery with the lowest complications rate.

Quantity-guided drain management reduces seroma formation and wound infections after radical lymph node dissection: results of a comparative observational study of 374 melanoma patients

Background: Lymphatic fistulas are common complications after lymph node dissections in melanoma patients. We investigated whether drain management could improve the patient’s outcome.Methods: Patients who underwent axillary or inguinal lymph node dissection (RALND or RILND) for malignant melanoma were recorded in a prospective database. Two different methods of drain management were compared. Either the drain was removed no later than the eighth postoperative day (period I, 2003–2007) or it was left in place until fluid flow was below 50 ml in 24 h for two consecutive days (period II, 2008–2011). The main outcome criterion was the incidence of seroma punctures after drain removal.Results: 374 patients were analysed. The incidence of seroma punctures significantly decreased in period II. The number of patients with elevated lymphatic secretions rose by 41.3% (RALND) and 38.1% (RILND). With the exception of lymphatic fistulas, we observed significantly more local complications with need for treatment in period I (n = 104, 52%) than in period II (n = 31, 18%). In period II, the hospital stays after both procedures were significantly reduced.Conclusions: We conclude that quantity-guided drain management leads to a prolonged interval of drainage but is associated with a lower incidence of seroma formation and shorter hospital stay.

Comparing Early Outcomes using Non Absorbable Polypropylene Mesh and Partially Absorbable Composite Mesh through Laparoscopic Transabdominal Preperitoneal Repair of Inguinal Hernia.

Laparoscopic hernia repair is in vogue in the present era. Both the operating surgeon and the patient are concerned about the postoperative inguinodynia which has now replaced recurrence as the predominant factor affecting quality of life. Our study aimed to compare early postoperative outcomes with the standard non absorbablepolypropylene and the newer partially absorbable composite meshes. A total of 60 patients with unilateral uncomplicated inguinal hernia were included in the study and randomly divided into two groups, one each for one kind of mesh. Patients underwent Transabdominal Preperitoneal (TAPP) repair of hernia after taking written informed consent. Follow up was done in the immediate postoperative period and at three months. Patients were compared for inguinodynia, sensation of heaviness, seroma/haematoma formation and return to work activities. Standard statistical tests were applied and a p-value <0.05 was taken as significant. Patients in the composite group complain of significantly less pain as compared to those with the non absorbable mesh at three months (p-value 0.003). They also report less sensation of heaviness over the groin area. However, incidence of seroma formation was higher in the composite group (20%) when compared to the non absorbable group (6.67%). An earlier return to work was seen in the patients with composite mesh. Use of composite mesh in TAPP is associated with better patient outcomes in terms of less postoperative pain and an earlier return to work.

A Double-Blinded Prospective Randomised Controlled Trial to Assess the Efficacy of Glubran-2 in Reducing Seroma Formation after a Mastectomy with or without Axillary Dissection

Background and Purpose: Seroma formation is a common complication following a mastectomy and axillary surgery. Decreasing the dead space is believed to decrease seroma formation. The aim of this study is to compare the incidence of seroma formation with the use of Glubran-2 versus normal saline during the wound closure in participants undergoing mastectomy with or without axillary dissection. Methods: This multicentre, prospective, double-blinded, randomised controlled trial, enrolled women 18 years of age or older with breast cancer, who were underwent total or partial mastectomy, with or without axillary dissection. Participants were randomised to Glubran-2 or Saline arm. The primary outcome was the volume and duration of wound seroma. Secondary outcome was post-operative wound infection. Results: A total of 76 women were randomised and there was no loss to follow-up or mortality. The total seroma volume was higher in the Glubran-2 arm. The duration of seroma was higher in the mastectomy and axillary dissection group in the Glubran-2 arm (P = 0.69). Elderly and participants with higher BMI had a higher volume of seroma. Post-operative infection rate was higher in the Glubran-2 arm (13.2% vs. 5.6%; P = 0.26). There was no statistically significant difference between the groups. Conclusion: Our study did not show any benefit with the use of Glubran-2 in mastectomy and axillary surgery in reducing the risk of seroma formation. In elderly and obese participants the use of Glubran-2 showed an increase in seroma formation and post-operative wound infection.

OK-432 (Sapylin) Reduces Seroma Formation After Axillary Lymphadenectomy in Breast Cancer

ABSTRACTPurpose/aim: Modified radical mastectomy is the standard surgery for breast cancer in developing countries. However, seroma formation regarded as the most frequent postoperative complication limits the therapeutic benefit of mastectomy and axillary surgery. The purpose of this study was to evaluate the efficacy of OK-432 in reducing seroma formation after axillary dissection. Methods: This prospective cohort study included 80 patients with advanced breast cancer who underwent modified radical mastectomy. Patients were randomized into two groups, which differed with the OK-432 administration. N = 40 patients per group were treated with either OK-432 plus closed suction drainage or drainage-only. Result: In comparison with the drainage-only group, we found that patients in the OK-432 group had a lower drainage volume (p = .030) and a shorter duration of axillary drainage (p < .01). Besides, the use of OK-432 could reduce the incidence of seroma formation (p < .01) and the volume of seroma (p = .040). There were also significant differences in reducing the chance of evacuative punctures (p = .036) and the healing time (p < .01) between control and OK-432 group. Conclusion: OK-432 not only shortened the suction drainage duration, but also significantly reduced seroma formation as well as the needs for aspiration punctures after modified radical mastectomy.

Does negative pressure wound therapy applied to closed incisions following ventral hernia repair prevent wound complications and hernia recurrence? A systematic review and meta-analysis

Despite advances in surgical technique, ventral hernia repair (VHR) remains associated with significant postoperative wound complications. A systematic review and meta-analysis was performed to identify whether the application of negative pressure wound therapy to closed incisions (iNPWT) following VHR reduces the risk of postoperative wound complications and hernia recurrence. The PubMed/MEDLINE, EMBASE and SCOPUS databases were searched for studies published through October 2015. Publications that met the following criteria were included: adult patients undergoing VHR; comparison of iNPWT with conventional dressings; and documentation of wound complications and/or hernia recurrence. The methodological quality of included studies was independently assessed using the Methodological Index for Non-Randomized Studies guidelines. Outcomes assessed included surgical site infection (SSI), wound dehiscence, seroma, and hernia recurrence. Meta-analysis was performed to obtain pooled ORs. Five retrospective cohort studies including 477 patients undergoing VHR were included in the final analysis. The use of iNPWT decreased SSI (OR 0.33 [95% CI 0.20 to 0.55]; P<0.0001), wound dehiscence (OR 0.21 [95% CI 0.08 to 0.55]; P=0.001) and ventral hernia recurrence (OR 0.24 [95% CI 0.08 to 0.75]; P=0.01). There was no statistically significant difference in the incidence of seroma formation (OR 0.59 [95% CI 0.27 to 1.27]; P=0.18). For patients undergoing VHR, current evidence suggests a decreased incidence in wound complications using incisional NPWT compared with conventional dressings.

Comparison Study Between Scalpel and Electrocautery, in Causation of Seroma After Modified Radical Mastectomy.

Worldwide, breast cancer is the commonest malignancy in female population, and an increasing number of women are undergoing modified radical mastectomy (MRM) as a treatment for breast cancer. Though for most patients mastectomy goes uneventful, but for some patients complications of mastectomy are seen that cause morbidity, prolong hospital stay, and delay the adjuvant treatment. Seroma is encountered as a commonest complication after mastectomy. Though various factors are suspected in causation of seroma, in this prospective study, we tried to evaluate outcome of two different surgical technique of MRM in causation of seroma formation. We randomized all patients of breast cancer undergoing MRM in to two groups; in one group, we used electrocautery for raising the skin flap and axillary dissection while in another group we used scalpel to raise the skin flap along with aid of scissors and suture ligation for axillary dissection. Incidence of seroma formation was compared in both the groups. Incidence of seroma was significantly more with use of electrocautery. Results in both the groups were compared by chi-square method, and statistically significant difference in incidence of seroma formation was found between two groups. So in breast surgery, there should not be an injudicious use of electrocautery.