Clinical and cost outcomes of a polyethylene glycol (PEG)-coated patch versus drainage after axillary lymph node dissection in breast cancer: results from a multicentre randomized clinical trial.

BACKGROUND: The aim of this study was to compare the clinical outcomes between breast cancer patients who underwent axillary lymph node dissection with postoperative management using a polyethylene glycol-coated patch versus axillary drainage. The direct costs associated with both postoperative management strategies were also evaluated. METHODS: This was a multicentre RCT in women with breast cancer who underwent axillary lymph node dissection (ClinicalTrials.gov identifier: NCT04487561). Patients were randomly assigned (1 : 1) to receive either drainage or a polyethylene glycol-coated patch as postoperative management. The primary endpoints were the need for an emergency department visit for any event related to the surgery and the rate of seroma development. RESULTS: A total of 227 patients were included , 115 in the patch group (50.7 per cent) and 112 (29.4 per cent ) in the drainage group. The incidence of emergency department visits was significantly greater for patients with drainage versus a polyethylene glycol-coated patch (incidence rate difference 26.1 per cent, 95 per cent c.i. 14.5 to 37.7 per cent; P < 0.001). Conversely, the seroma rate was significantly higher in the polyethylene glycol-coated patch group (incidence rate difference 22.8 per cent, 95 per cent c.i. 6.7 to 38.9 per cent; P < 0.0055). Compared with drainage, using a polyethylene glycol-coated patch resulted in cost savings of €100.41 per patient. An incremental cost-effectiveness ratio analysis found that drainage was associated with an incremental cost-effectiveness ratio of €7594.4 for no need for hospital admission and €491.7 for no need for an emergency department visit. CONCLUSION: Compared with patients who received drainage after axillary lymph node dissection, the use of a polyethylene glycol-coated patch resulted in a higher rate of seroma, but a lower number of postoperative outpatient or emergency department visits and thus a reduction in overall costs.

LAPAROSCOPIC INGUINAL HERNIA REPAIR: THE LONG-TERM ASSESSMENT OF CHRONIC PAIN AND QUALITY OF LIFE.

BACKGROUND: Laparoscopic approaches to inguinal hernia repair include transabdominal extraperitoneal and transabdominal preperitoneal, both of which are widely performed and employ mesh. Indicators of success for these surgical procedures include incidence of complications, time to return to daily activities, incidence of postoperative chronic pain, and the long-term postoperative patient satisfaction. OBJECTIVE: This study aimed to evaluate and compare long-term postoperative incidence of chronic pain and overall quality of life among patients undergoing transabdominal extraperitoneal or transabdominal preperitoneal inguinal hernia repair. METHODS: This was a retrospective cross-sectional study. Medical records were analyzed, and the SF-36 questionnaire and Visual Analog Scale were applied to assess quality of life and chronic pain in patients undergoing laparoscopic inguinal hernia repair between January 2017 and February 2021. RESULTS: A total of 167 patients status post laparoscopic inguinal hernia repair, who were 3 months postoperatively or longer, were included in the study. Among the early complications seen, seroma was most common in the transabdominal preperitoneal group (p=0.04). Subsequently, 40 of the initial 167 patients answered to the survey instrument (SF-36 and Visual Analog Scale). Mean patient-reported pain (Visual Analog Scale score) was statistically similar between groups, with 1.29 for transabdominal preperitoneal and 1.68 for transabdominal extraperitoneal (p=0.92). In the domains evaluated by the SF-36, there was no significant difference between the samples. CONCLUSION: Both transabdominal extraperitoneal and transabdominal preperitoneal techniques for hernia repair have similar results in the late postoperative period regarding quality of life and prevalence of chronic pain. They are also comparable in terms of major early postoperative complications, except for seroma, with a higher incidence in patients undergoing transabdominal preperitoneal.

Effect of harmonic scalpel on seroma formation following surgery for breast cancer: a prospective randomized study.

PURPOSE: With the escalating cost of healthcare provision, surgical techniques that could lead to shorter postoperative stay and reducing cost of health provision are welcomed. We report the results of a prospective randomized trial to investigate the role of harmonic scalpel (HS) in reducing postsurgical seroma formation, complications, pain and consequent cost in breast surgery. PATIENTS AND METHODS: Thirty-three procedures were carried out on 32 women. Patients were prospectively randomized to either HS or electrocautery (EC). The two cohorts were accordingly matched and postsurgical seroma volumes, complications and pain scores were documented. RESULTS: There were 16 procedures in the HS and 17 in the EC group. First 48 h drainage, total drained volume, aspirated volume, operative time, pain score, number of patients that developed seromas, number of clinic visits for aspiration, complications and required analgesia were comparable in the two groups. Multivariate analysis showed no significant correlation between the total amount of seroma drainage and the known risk factors (body mass index/BMI, size of the invasive tumor and number of positive nodes). CONCLUSION: No significant reduction in seroma formation or wound complications and pain could be found with the use of HS. We were unable to demonstrate any significant clinical advantages with the use of HS or cost benefit.

Incidence and management of seroma after arteriovenous graft placement.

BACKGROUND: Perigraft seromas are rare complications of insertion of PTFE hemodialysis grafts. They are often difficult to treat and recurrence is common. This study evaluates the incidence, potential etiologic variables, and management strategies for seromas after prosthetic arteriovenous graft (AVG) placement. STUDY DESIGN: A retrospective analysis of all patients undergoing AVG placement between August 2002 and December 2005 was performed to identify all patients diagnosed with seroma requiring surgical intervention. Multiple variables were analyzed to determine potential risk factors for seroma formation and outcomes of various forms of surgical management. RESULTS: In this interval, 535 AVG were inserted in 427 patients. Ten patients presented with a seroma and underwent surgical treatment. Overall incidence of seroma formation was 1.7%. There was no significant difference in seroma formation based on gender, age, diabetes, lower extremity versus upper extremity placement, or loop forearm versus straight forearm grafts. A statistically significant difference was found between upper arm (p = 0.007) and lower arm grafts (p = 0.04), with upper arm grafts more prone to seroma formation. Patients undergoing bypass of the seromatous segment of graft have not had a recurrence, compared with those who were simply evacuated and have had a mean patency of 402 days. CONCLUSIONS: Seroma complications after AVG insertion are higher in patients with upper arm grafts. To minimize this complication, meticulous operative technique is required. If a seroma develops, the graft might still be salvageable with aggressive management, including bypass of the involved segment.