Incidence Of Seroma Formation Research Articles

Efficacy of perioperative systemic tranexamic acid along with topical hemocoagulase in decreasing axillary drain output in breast cancer patients undergoing axillary lymph node dissection: A randomized, double-blind, placebo-controlled, superiority trial.

Excess and prolonged axillary drainage is a frequent nuisance following axillary lymph node dissection (ALND) in breast cancer patients. No consensus exists about the best method to prevent this consistently and reliably. Tranexamic acid (TA) has been found to reduce the amount and duration of drainage, but the reduction is not optimal. We hypothesized that systemic administration of TA along with the topical application of hemocoagulase (H) to the axillary dissection bed may decrease the cumulative axillary drain output and shorten the requirement of drainage after ALND as compared to placebo. Seventy women undergoing ALND for breast carcinoma were randomized into two groups, the intervention (TA+H) group and the control (C) group. The cumulative drain output (primary objective), duration of drainage, incidence of seroma formation after drain removal, number of seroma aspirations required, volume of seroma aspirated, and incidence of surgical site infection (SSI) were compared. The mean cumulative output in the TA+H group was significantly lower than the C group (290±200mL vs. 552±369mL, p<0.001). Axillary drains were removed significantly earlier in the TA+H group (6.6±2.2 vs. 11.7±6.0days, p<0.001), but the incidence of seroma formation (p=0.34), number of aspirations required (p=0.33), volume of seroma aspirated (p=0.47), and the incidence of SSI (p=0.07) were similar. Perioperative systemic administration of tranexamic acid along with topical application of H to the axillary dissection bed is effective in reducing cumulative axillary drain output after ALND. This strategy may also facilitate earlier removal of suction drains.

Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial.

We evaluated the impact of topical epinephrine with xylocaine on drainage after axillary lymph node dissection. Fifty-two women were randomized into two groups, epinephrine with xylocaine drainage (ED) and conventional drainage group (CD). The amount of drainage, duration of drainage catheter, incidence of seroma formation and wound infection were noted. The mean total drainage volume was less in ED group as compared to CD group (195ml vs. 353ml; p = .002). Drainage catheter was removed earlier in ED group as compared to CD group (5.07 + / - 0.99days vs. 6.65 + / - 1.07days; p = 0.0001). The incidence of seroma and wound infection was similar in two groups. Topical epinephrine with xylocaine after axillary lymph node dissection results in significantly decreased drainage volume and duration of drainage.

A Comparative Study Between Mastectomy Flap Quilting Sutures with Axillary Drain Versus Conventional Sutures with Axillary and Pectoral Drain in Reducing Post-Modified Radical Mastectomy Seroma Formation.

The aim of this study was to compare quilting suture with axillary drain versus conventional sutures with axillary and pectoral drain on the formation of seroma after modified radical mastectomy with axillary lymph node dissection. The study was undertaken among 90 female patients with breast cancer who were candidates for modified radical mastectomy with axillary clearance. The intervention group (N = 43) with quilting and axillary drain placement and the control group (N = 33) without quilting with axillary and pectoral drain placement. All the patients were followed up for complications pertaining to this procedure. There were no significant differences between the two groups with regard to demographic characteristics, comorbidities, pre-operative chemotherapy, post-operative pathological findings, lymph node involvement or clinical staging. The incidence of seroma formation on follow-up was significantly lower in the intervention group than that in the control group (23% versus 58%; p < 0.05) whereas there was no significant difference with respect to flap necrosis, superficial skin necrosis and wound gaping between the two groups. Furthermore, it took a shorter duration for seroma to resolve in the intervention group (4days versus 9days; p < 0.001) with a smaller duration of hospital stay (4days versus 9days; p < 0.001). The use of quilting sutures for flap fixation in order to obliterate dead space post-modified radical mastectomy with placement of axillary drain significantly reduced seroma formation along with shorter duration of wound drainage and a smaller hospital stay with only slightly increased operative time. Therefore, we recommend quilting of flap as a routine step after mastectomy.

A newer method of seroma reduction by fenestration of pseudo-sac during laparoscopic repair of direct inguinal hernia: A randomised, controlled pilot study.

Minimally invasive surgeries for inguinal hernia repair have been reduced post-operative morbidity. However, certain complications such as seroma formation are unavoidable. In this study, we introduce a newer technique of reducing seroma formation by fenestration of the pseudo-sac (thickened transversalis fascia) in patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. A randomised, controlled pilot study was conducted from January 2019 to December 2020 for the patients undergoing laparoscopic hernia repair for uncomplicated direct inguinal hernia. Study participants were randomised into interventional group and control groups. Demographics, operative duration and complications including post-operative pain and seroma on days 1, 10 and 30 were analysed between both the groups. A total of 20 cases with 30 hernias were included in the study. Demographic data were comparable between the two groups. The intervention group showed a statistically significant decrease in the incidence of seroma formation on the post-operative day 10 (13.3% vs. 46.6%, P = 0.046). The mean volume of seroma on day 10 was also less compared to the non-fenestration group (2.5 vs. 6.58 ml, P = 0.048). After the 30th day, no patient had a presence of seroma. There were no statistically significant differences in terms of mean operative duration, post-operative pain and other complications. Fenestration of pseudo-sac in laparoscopic hernia repair for uncomplicated direct inguinal hernia is a simple and effective technique. It has reduced the incidence and volume of seroma formation without any increased risk of infection, acute or chronic pain and recurrence.

LIGHT WEIGHT VERSUS MEDIUM WEIGHT MESH IN LAPAROSCOPIC INGUINAL HERNIA MESH REPAIR

Hernia is repaired by laparoscopic or open approach. Laparoscopic inguinal hernia repairs performed are trans-abdominal preperitoneal repair (TAPP) and totally extra-peritoneal repair (TEP). This study aimed to update the previous reviews and to compare Light Weight versus Medium Weight Mesh in LIHR. Previous studies have shown benets of LWM compared to MWM in terms of decreased pain, discomfort, and early return to normal activity. Method: 50 patients operated for Laparoscopic Inguinal Hernia Mesh Repair were evaluated from Inpatient department of Sahyadri Speciality Hospital, Deccan, Pune between January 2020 to May 2021. 30 patients were operated using Anatomical 3D Light weight Mesh and 20 were operated using Paritene Flat Sheet Medium Weight Mesh; allocation done by simple randomization. It is a prospective, observational study. Aim was to evaluate the post-operative outcome and return to normal activities in LWM versus MWM in LIHR. Result: Mean duration of hospital stay, mean duration of days taken to resume daily activities, intensity of pain by VAS and NRS, foreign body sensation, incidence of seroma formation and inuence on male sexual life and fertility did not differ between patients of both groups. No signicant difference in post-operative pain and foreign body sensation between use of LWM and MWM.

A Study To Assess Desarda Vs Lichtenstein Technique For The Treatment Of Primary Inguinal Hernia

Background: The present study was conducted for assessing and comparing the efficacy of Desarda vs Lichtenstein technique for thetreatment of primary inguinal hernia.Materials &amp; Methods: 100 patients scheduled to undergo treatment for inguinal hernia were enrolled. Complete demographic andclinical details of all the patients was obtained. All the patients were randomized into two study groups: Group A (50 patients)-undergoing treatment by Desarda technique, and Group B (50 patients)- undergoing treatment by Lichtenstein technique. Forperforming Lichtenstein tension-free mesh repair, a polypropylene mesh was trimmed to fit the inguinal floor. Chronic pain wasassessed on a VAS score of 0 to 10 with 7 to 10 indicating strong pain while 3 to 6 indicating moderate pain. All the results weresubjected to statistical analysis using SPSS software.Results: Group A and group B subjects took 15.3 days and 14.2 days respectively for returning to basic activity. Group A and groupB subjects took 5.1 days and 8.3 days respectively for returning to home activity (p- value &lt; 0.05). Mean hospital stay was 3.2 daysand 2.9 days among subjects of group A and group B respectively. Foreign body sensation was felt in one patient each of both thestudy groups. Incidence of seroma formation was higher among the patients of group B in comparison to patients of group A. Meanoperative time was significantly lower among patients of group A.Conclusion: Outcome is better for Desarda technique in comparison to Lichtenstein technique for the treatment of primary inguinalhernia.

Using Drain-Free Flap Fixation Techniques Versus Traditional Wound Closure With Drain Placement to Prevent Seroma Formation and Its Complications in Breast Cancer Patients Undergoing Mastectomy: A Systematic Review and Meta-analysis.

During the past decade, there has been some controversy related to using flap fixation techniques instead of conventional wound closure methods and drain placement during mastectomy procedures. The purpose of our study was to address this controversy using a systematic review and meta-analysis of current published literature. Nineteen studies met our inclusion criteria. Our sample population consisted of 2,956 participants divided into two groups. The study group (SG) consisted of 1,418 individuals and the control group (CG) consisted of 1,538 participants. We found there was a significant reduction in the incidence of seroma formation (odds ratio [OR] = 0.35; 95% confidence interval, CI [0.3, 0.42]; p < .000) and surgical site infection (OR = 0.65; 95% CI [0.48, 0.88]; p = .006) in the SG compared with the CG. The length of hospital stay was also significantly reduced in the SG (0.59 days; 95% CI [0.73, 0.46]; χ 2 [6, N = 502] = 52.88; p < .000) compared with the CG. The results of our study show that using a flap fixation technique after mastectomy can decrease the patient's risk for seroma formation and surgical site infection while reducing their length of hospital stay. Further studies with longer follow-up periods are warranted to evaluate long-term complications associated with using a flap fixation technique compared with using conventional wound closure techniques and drain placement.

Open versus laparoscopic intraperitoneal on-lay mesh repair: A comparison of outcomes in small ventral hernia

PurposeThe ideal surgical treatment of small ventral hernias (defect less than 4 cm) is still debatable. In our study, we sought to compare the outcomes of open versus laparoscopic intraperitoneal on-lay mesh (IPOM) repair in small ventral hernias. MethodsPatients with a single ventral hernia defect of less than 4 cm undergoing surgical mesh repair between January 2016 and September 2018 were prospectively registered for this study. The minimum follow-up duration was 12 months. Patient demographics, operative findings and regular post-operative follow-up details including recurrence rates and complications were recorded and analysed. Results41 patients underwent laparoscopic IPOM repair and 47 patients underwent open IPOM repair. The mean age for both groups is similar with no significant difference. The mean hernia defect size for the laparoscopic group is 2.8 cm (±0.8) whereas the mean hernia defect size for the open repair group is 2.1 cm (±0.4). The mean surgery duration for open IPOM repair was significantly shorter (59 min (±17) vs 74 min (±26); p = 0.001). There was no significant difference in the incidence of seroma formation and surgical site infections post-operatively. There was also no significant difference in both groups in terms of chronic pain and recurrence at 1-year follow-up. ConclusionOpen IPOM repair for small ventral hernias may be superior to laparoscopic IPOM repair due to the shorter operative duration, single incision, and no additional risk of port-site hernias. There was no difference in chronic pain, wound infection and recurrence rate between the two groups.

Effect of Mastectomy Flap Fixation on Post-operative Fluid Drainage and Seroma Formation in Breast Cancer Patients A Double-blinded Randomised Control Trial.

&lt;b&gt; Introduction:&lt;/b&gt; Post-operative seroma formation is one of the most common complications following modified radical mastectomy (MRM). Quilting is a technique where the mastectomy flaps are sutured to the underlying chest wall muscles with sutures, obliterating the dead space. The authors hypothesised that post-mastectomy dead space obliteration by intermittent mastectomy flap fixation leads to decreased drain output and seroma formation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt; Material and methods: &lt;/b&gt; A double-blinded randomised control trial with two arms was conducted from November 2019 to March 2021 in our institute located in India. Patients with non metastatic breast carcinoma planned for MRM were randomly categorised into two groups of 35 patients each. In the test group, each flap was fixed to the underlying muscle using four intermittent 3-0 polyglactin sutures, which was followed by skin closure, and only skin closure was done in the control group. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Results:&lt;/b&gt; The test and control groups did not differ significantly with respect to demographic and tumour characteristics. The average drain output of the test group (155.43 ml) was significantly less than of the control group (206.29 ml). The overall incidence of seroma formation is lower in the test group (5.7%) when compared to the control group (28.6%). The duration of hospital stay in the test group (4.63 days) was significantly shorter when compared to the control group (6.66 days). There was no significant increase in the overall operating time or complications like surgical site infection or skin dimpling due to flap fixation. &lt;/br&gt;&lt;/br&gt; &lt;b&gt;Conclusions:&lt;/b&gt; Fixation of MRM flaps is associated with better post-operative outcomes related to drain output and seroma formation without a significant increase in other morbidities or usage of resources.

“COMPARATIVE STUDY BETWEEN PREPERITONEAL AND INTRAPERITONEAL ONLAY MESH REPAIR OF VENTRAL HERNIA”

In this study we compare the results between Preperitoneal and Intraperitoneal Onlay Mesh Repair of Ventral Hernia. It is a Prospective Randomized Controlled study conducted in a tertiary care centre in Eastern India between September 2018 and March 2020.In this study 78 patients were enrolled. They are randomized into two groups. About 65% of patients who enrolled for the study are females. 12% patients had Umbilical hernia, 55% had Paraumbilical hernia and 24% had Epigastric hernias. Patients with Incisional Hernia were not included. The mean duration of surgery, hospital stay and pain score (as per the visual analog scale) was signicantly less in IPOM compared to PPOM. There was no Haematoma formation in either of the groups. Return to normal work was signicantly earlier in the group undergoing IPOM over those undergoing PPOM. Patients undergoing IPOM were more satised with the cosmetic appearance in the post-operative period as compared to those undergoing PPOM however the incidence of seroma formation was more in the former.

Effect of Octreotide on Lymphorrhea in Patients After Modified Radical Mastectomy for Carcinoma Breast: A Randomized Controlled Trial.

IntroductionLymphorrhea or seroma formation after modified radical mastectomy (MRM) is a serious and disabling complication of axillary lymphadenectomy. Octreotide is a hormone with general anti-secretory effects. The potential role of octreotide in the treatment of lymphorrhea after axillary lymph node dissection in patients undergoing MRM is being investigated in this study. The purpose of this research is to study the effect of octreotide on the magnitude and duration of lymphorrhea in patients after MRM for carcinoma breast.MethodsThis clinical trial was registered in the Clinical Trials Registry India (CTRI/2017/11/010653). It was conducted in the Department of General Surgery, Maulana Azad Medical College and associated Lok Nayak Hospital, New Delhi from September 2015 to March 2017. This study is a parallel randomized controlled trial with a 1:1 allocation ratio. Thirty patients were enrolled and allocated equally into two groups. The intervention group received standard medical care plus injection octreotide 100 micrograms eight hourly intravenously post-operatively for five days and the control group received only standard medical care. The primary outcomes were lymphorrhea volume from 24 hours post-surgery till five days post-operatively and the number of days till the suction drain was removed. Secondary outcomes were surgical site infection, the incidence of seroma formation, complications of octreotide, duration of hospital stay, and the number of lymph nodes isolated. All the patients were followed up twice a week for the first six weeks after discharge followed by three monthly visits.ResultsA total of 30 patients were included in the study. The mean age was 46.2 years. The mean operative time in the control group was 137.87 ± 23.28 minutes and in the octreotide group was 128.13 ± 12.29 (p = 0.163). The volume of lymphorrhea in the control group was 354.67 ± 346.28 ml and in the octreotide group was 194.00 ± 240.62 ml (p = 0.081). Seroma occurred in 9% of patients in the control group and 2 % of patients in the octreotide group (p = 0.010). The duration of lymphorrhea was 4.93 ± 2.49 days in the control group and 3.13 ± 1.36 days in the octreotide group (p = 0.029). The duration of stay was 7.07 ± 2.40 days in the control group and 5.13 ± 1.06 days in the octreotide and was found to be statistically significant (p = 0.010). No obvious adverse reactions related to injection octreotide, namely, nausea, vomiting, abdominal discomfort, hypotension, bradycardia, and dysglycemia, were seen in any of our patients.ConclusionThe duration of lymphorrhea, incidence of seroma formation, and duration of hospital stay were lesser in the octreotide group, and the difference was statistically significant. The wound infection rates were similar in both groups. Thus injection octreotide can be used safely and effectively.

Correlation between C-reactive protein, intravenous hydrocortisone, systemic tranexamic acid and post mastectomy seroma

Background: Breast cancer is the second leading cause of death among women worldwide. Formation of a seroma most frequently occurs after mastectomy and axillary surgery. The objective was to find the correlation between the formation of post modified radical mastectomy seroma and C-reactive protein (CRP) and the effect of preoperative intravenous (IV) hydrocortisone, systemic tranexamic acid.Methods: This prospective study was conducted at Menoufia university hospital on female patients with primary operable breast cancer who were divided to two groups; each included 30 patients: group I received general anesthesia with hydrocortisone therapy (Solu-Cortef 100 mg solution once), systemic tranexamic acid (kapron 5 ml once) and group II received general anesthesia without hydrocortisone nor tranexamic acid. CRP serum levels before surgery and 24 hour after the procedure. All patients were followed up postoperatively for registration of the total drainage volume until drain removal, timing of drain removal, incidence of seroma formation and management of seroma.Results: Our results revealed that a significant difference between both groups as regard CRP, the incidence of seroma, time of removing the drain and total collection of the drain in favor to those who received IV hydrocortisone and systemic tranexamic acid.Conclusions: Induction of IV hydrocortisone, systemic tranexamic acid with general anaesthesia during modified radical mastectomy (MRM) are significantly decreasing the level of CRP, the incidence of seroma, time of removing the drain and total collection of the drain.

COMPARISON OF SINGLE VERSUS DOUBLE DRAIN ON POSTOPERATIVE SEROMA FORMATION FOLLOWING MODIFIED RADICAL MASTECTOMY IN A TERTIARY CARE CENTRE IN NORTH INDIA

INTRODUCTION: The usefulness of drains on seroma formation after surgery for breast cancer is the most investigated and most controversial topic of debate for the clinical researchers. Hence this study was conducted to compare single drain and double drain among women with breast cancer who underwent MRM in preventing seroma formation and also to determine the role of other predictors on the same. MATERIAL AND METHODS: A hospital based non-randomized controlled trial was conducted among 84 women (42 women each in single drain and double drain group respectively) with breast cancer who underwent modied radical mastectomy in the department of General Surgery, GSVM Medical College, Kanpur from January 2019 to October 2020. All women were followed up after insertion of either single or double drain following MRM for seroma formation. The mean age of the study RESULTS: participants was 46.4 (12.1) years. The incidence of seroma formation was found to be 26.2% (95% CI: 17.5%-37.1%). On logistic regression 2 analysis there was a signicant association for BMI &gt; 25 kg/m , hypertension and lymph node status with seroma formation. However, there was no signicant association for age, Diabetes Mellitus and number of drains (p&gt;0.05) in logistic regression analysis. CONCLUSION AND RECOMMENDATIONS: Single or double drain techniques are equally effective in reducing the seroma formation ad associated complications following modied radical mastectomy. Lymph node status, BMI and hypertension were found to inuence seroma formation in our study. Further research with a larger sample size at a multicentric level is needed to make our study results robust for better management of these patients.

“PROSPECTIVE RANDOMISED COMPARATIVE STUDY OF USE OF FIBRIN GLUE VS. TACKERS AS METHOD OF MESH FIXATION IN LAPAROSCOPIC TRANSABDOMINAL PRE-PERITONEAL (TAPP) HERNIA REPAIR”

BACKGROUND: Fixation of mesh in pre-peritoneal space is an important step in laparoscopic TAPP hernia repair. Mesh dislocation is one of the most frequent causes responsible for recurrence. Of the many factors inuencing postoperative pain, the technique of xation has been reported to be one of the most signicant determinants. So mesh xation with adhesives instead of mechanical devices has been proposed as a mean to reduce the incidence of postoperative pain. AIM: To compare clinical outcome and morbidity of xation of mesh using brin glue and tackers in trans-abdominal pre-peritoneal inguinal hernia repair METHODOLOGY: We did a prospective randomized comparative study in which we enrolled 50 patients undergoing laparoscopic hernia repair (TAPP). Those who met our inclusion criteria were randomized for study purpose after obtaining informed consent, in 25 patients mesh xed with tackers (group A) and in other 25 patients mesh xed with brin glue (group B). Patients were compared for intraoperative time required for mesh xation, early and late postoperative pain, time required to resume normal daily physical activity, length of hospital stay, hernia recurrence and seroma formation. Postoperative follow up was done up to six months. RESULTS: Two groups were comparable in terms of demographic variables. We observed that postoperative pain, time required resuming normal daily activity and incidence of seroma formation was less in group B (Mesh xed with glue). There was no signicant difference in length of hospital stay in both groups and no evidence of hernia recurrence in both groups during follow up period. CONCLUSION: It can be concluded that xation of mesh with brin glue when compared with tackers, seems to reduce postoperative pain, time to resume daily activities and incidence of seroma formation with no difference in length of hospital stay, early hernia recurrence with longer operative time.

Improved Perioperative Seroma and Complication Rates Following the Application of a 2-Layer Negative Pressure Wound Therapy System After Inguinal Lymphadenectomy for Metastatic Cutaneous Melanoma

BackgroundPerioperative complications following inguinal lymphadenectomy, including seroma formation, are frequent. We have employed a 2-layer negative pressure wound therapy (2-LNPWT) as a method to reduce seroma rate and perioperative complications. We present the outcome of our initial experience with 2-LNPWT and compare the outcomes of its use with traditional closed suction drains (CSDs).Materials and methodsA non-randomised retrospective case–control series was analysed. Surgeons performing inguinal lymphadenectomy for metastatic cutaneous melanoma utilised either the 2-LNPWT therapy or traditional CSDs according to their practice preference.ResultsThe study included 111 patients. The cohorts were well matched for gender, disease burden, body mass index and comorbidities. The 2-LNPWT technique was associated with significantly better postoperative outcomes than CSD, in terms of incidence of seroma formation (26.9% vs 49.4%; p < 0.03), period of drainage (15 days vs 20 days; p = 0.005) and return to theatre rate (0% vs 15.3%; p = 0.03). The overall seroma rate was 44.1%. The only significant association with seroma initiation was the type of drainage system used (2-LNPWT 31.2% vs CSD 58.3%; p < 0.03; OR 3.0). The method of drainage did not alter the course of an established seroma. There was no significant difference in overall or disease-specific survival detected between the 2 groups.ConclusionThis retrospective non-randomised case control study has demonstrated the safe use of a novel application of negative pressure wound therapy that significantly reduced the incidence of seroma formation and postoperative complication rate for inguinal lymphadenectomy for melanoma.

Comparison of frequency of seroma formation in flap fixation versus conventional closure after modified radical mastectomy.

Seroma formation is a known complication after any surgery where excessive dissection of subcutaneous tissue leads to disruption of lymphatic channels. Seroma formation, its sequelae and frequent visits to doctor for their management are a common source of discomfort for patients. Objectives: Comparison of frequency of seroma formation after flap fixation versus convetional closure after modified radical mastectomy. Study Design: Randomized control trial. Setting: Department of Surgery, Allied Hospital Faisalabad. Period: 6 months from May 1, 2016 to October 31, 2016. Material &amp; Methods: After permission from Hospital ethics committee and informed consent from patients, 70 patients were randomly divided into two groups (35 participants in each group). Findings were noted and data was analyzed statistically. Results: It was observed that incidence of seroma formation following modified radical mastectomy was lower with flap fixation technique (14.29%) as compared to conventional closure of wound margins (42.86%). Conclusion: Flap fixation technique is better approach compared to conventional method to prevent seroma formation.

Comparison between Scissors and Electrocautery in Seroma Formation Following Modified Radical Mastectomy (MRM)

Background and Objective: Seroma is encountered as the commonest complication after mastectomy. Though various factors are suspected in causation of seroma, in this prospective study we tried to evaluate role of two different surgical technique of MRM in causation of seroma formation.&#x0D; Materials and Methods: In this observational comparative study, a total 90 patient of early breast carcinoma who had undergone Modified Radical Mastectomy (MRM) in 3 tertiary care hospitals of Dhaka were divided into 2 groups. In Group A, we used electrocautery for raising the skin flap and axillary dissection while in Group B we used curved Metzenbaum scissors to raise the skin flap along with aid of suture ligation for axillary dissection. Incidence of seroma formation was compared in both the groups.&#x0D; Results: Incidence of seroma was significantly higher 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.&#x0D; Conclusion: Breast surgery, as MRM does not support injudicious use of electrocautery.&#x0D; Journal of Surgical Sciences (2019) Vol. 23(2): 87-89

Does the use of monopolar energy as the preferred mode of dissection effectively reduce seroma formation in laparoscopic total extra peritoneal hernioplasty? A prospective double-blinded randomized control trial.

Seroma is a commonly encountered sequela after hernia repair. Tremendous effort has been spent to investigate the effective way to prevent this "complication" including the modification of surgical technique, use of per-peritoneal drainage, etc. There were debates about the use of monopolar diathermy versus blunt dissection in laparoscopic TEP in the prevention of seroma formation. This randomized study aims to compare the effects of using 2 techniques in laparoscopic TEP on pre-peritoneal drain output and seroma formation. From 1.9.2018 to 30.9.2019, all male and female patients presented with the first occurrence, unilateral inguinal hernia anticipated for laparoscopic TEP were enrolled into the study after informed consent. Patients were randomized into "monopolar dissection preferred" (MDP) group and "blunt dissection-preferred" (BDP) group just before commencing of operation after general anesthesia. Surgeons were instructed to use monopolar energy as main dissection method for the whole operation if possible (MDP), whereas blunt dissection is the preferred choice in BDP group, but the use of monopolar energy was allowed if needed. Total energy time was measured by a specially designed homemade device attaching to the monopolar pedals as accurate as to millisecond (ms). Pre-peritoneal drains were inserted for drainage and removed 23h after operation. Drainage output, total operating time, energy time, clinical and ultrasonic seroma sizes at day 1, day 6, 1-month post operations, recurrence are compared between 2 groups. A total of 103 patients where included. There was no significant difference in age, gender, co-morbidities, side of hernia, mean defect size, operating time, fixation adjuncts, or postoperative stay. The drain volume in BDP group is 71.13 ± 31.42mL while it in MDP group is 56.36 ± 21.46mL. The MDP group had significantly fewer drain output at 23h post operation (p = 0.007) and lower seroma incidence on days 6 (p = 0.036). Overall incidence of seroma formation was 12% on postoperative day 1, 11% on postoperative day 7. No statistically differences in postoperative pain score or complications were observed at the first week, 1- and 3-months' post operation. There was no correlation with energy time to the drain output. No recurrence was found in subsequent follow-up. Pre-peritoneal drainage is clinically safe in laparoscopic totally extra-peritoneal hernioplasty and can effectively reduce the size and incidence of seroma. The seroma formation can be further reduced by appropriate use of monopolar energy as preferred dissection approach in lap TEP. Due to limitation in measuring the actual energy time, the result should be further validated by randomized multi-centers trial on its potential benefit in hernia repair by a more accurate measuring device on energy used.

Fascia Suture Technique Is a Simple Approach to Reduce Postmastectomy Seroma Formation.

PurposeSeroma formation is a common complication in breast cancer patients undergoing mastectomy, and it negatively affects patient recovery after surgery. The present study aimed to evaluate a simple method using fascia suture technique to fix the flap and reduce the incidence of seroma.MethodsA single-center, prospective, randomized controlled trial was carried out among 160 patients who had undergone mastectomy from May 2018 to September 2019. All patients were randomly divided into the fascia suture group (n = 80) or control group (n = 80) and were followed up for at least 3 months for the assessment of immediate and late complications after surgery.ResultsNo significant differences were observed between the 2 groups with regard to the basic characteristics. Duration of surgery in the fascia suture group was longer by about 6 minutes compared with that in the control group (114.93 ± 13.67 minutes vs. 108.81 ± 15.20 minutes, p = 0.008). The fascia suture group had a shorter duration of drain placement (10.99 ± 3.26 days vs. 13.85 ± 5.37 days, p < 0.001), a smaller volume of the total drainage (460.95 ± 242.92 mL vs. 574.83 ± 285.23 mL, p = 0.007), and the first 3-day drainage (224.96 ± 101.01 mL vs. 272.3 ± 115.47 mL, p = 0.006), compared with the control group. The incidence of seroma formation (G2 or G3) was significantly lower in the fascia suture group compared with the control group (28.8% vs. 12.5%, p = 0.033). Besides, there was no statistical difference between the 2 groups in the assessment of other complications, including postoperative pain, hematoma, surgical site infections, flap necrosis, and skin dimpling (all p > 0.050).ConclusionThe fascia suture technique is a simple and effective method for reducing seroma formation and should be used to prevent seroma formation after mastectomy.Trial RegistrationChinese Clinical Trials Registry Identifier: ChiCTR1800015913

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.