Primary abandon of hernia sac for inguinoscrotal hernias: a safe way to cut corners.

INTRODUCTION: Inguinoscrotal hernias (ISH) pose a challenge to surgeons with consistently higher rates of postoperative complications and recurrence rates. The aim of this study is to report our initial experience and early results with a new technique for inguinoscrotal hernia repair. METHODS: A review of a prospectively maintained multi-center database was conducted in patients who underwent minimally invasive repair using the "primary abandon-of-the-sac" (PAS) technique for inguinoscrotal hernias from March 2021 to July 2022. Demographics and outcomes were analyzed. Univariate analysis and multivariate logistic regression were performed. RESULTS: A total of 76 minimally invasive inguinal hernia repairs were performed. In 70 patients (92%) C-PAS was used as the technique to abandon the sac while in the remaining 6 patients, "pirate-eye-patch" technique was used. Median hernia ring was 3 (IQR 2.5-3.5) cm and median hernia sac was 9.5 (8-10.8) cm. Median operative time was 70 min (IQR 56-96). Seroma was present in 22 (28.9%) patients 7 days after surgery. Most had seroma only in the inguinal area (n = 19; 25%). Thirty days after surgery, 12 (15.8%) patients still had seroma in the inguinal area and 6 (7.9%) in the inguinoscrotal area. Ninety days after surgery, four (5.3%) patients had inguinal seroma, 2 (2.6%) scrotal seromas and 3 (3.9%) inguinoscrotal seromas. The size of the hernia sac was not associated with seroma formation 7 days after surgery (OR 1.06; 95% CI 0.89-1.2; P = 0.461) in the multivariate logistic regression. BMI was also not associated with seroma formation (OR 0.8; 95% CI 0.74-1.06; P = 0.2). CONCLUSIONS: Planned abandon of the hernia sac is an interesting alternative and is associated with a low rate of complications and acceptable seroma formation rates.

Intramuscular Gluteoplasty: A Comparative Study between Different Incisional Access Routes.

BACKGROUND: Silicone implants have been used to improve volume and body contour in buttocks for almost 45 years. Although the intramuscular plane continues to be the standard, surgeons still diverge on the best incision technique: using a vertical incision, and thus without the preservation of the intergluteal groove, or preserving this area through a triangular dissection. The goal of this research study was to evaluate and compare these techniques of intramuscular augmentation gluteoplasty. METHODS: Two randomized groups were formed with 53 patients in each group. One of the groups underwent intramuscular gluteoplasty with a vertical incision in the intergluteal groove, and therefore without the preservation of said intergluteal groove (group A). In the other group, intramuscular gluteoplasty was performed using a triangular dissection, thus preserving the intergluteal groove (group B). The groups were compared in relation to the incidence of complications (ie, dehiscence, hematoma, seroma, and infection). RESULTS: A total of 7.5% of patients in group A presented dehiscence and 1.9% presented seroma. In group B, however, 28.3% of patients presented dehiscence and 7.5% presented seroma and dehiscence during the first 21 days after surgery. No patient had hematoma or infection in either group. CONCLUSION: In the comparison between the groups of patients, the technique with a vertical incision in the intergluteal groove showed a lower number of surgical wounds, dehiscences, and seromas when compared with the technique that preserves the intergluteal groove. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

Invited Discussion on: Global Prevalence and Preferences of Progressive Tension Suture Usage in Abdominoplasties.

The effectiveness of using quilting/progressive tension sutures in reducing seroma formation after abdominoplasties is well established in the literature, eliminating the use of drains regardless of the simultaneous performance of liposuction. However, despite being widely studied and advocated, the quilting/progressive tension sutures technique is still not widespread, and most surgeons still insist on the use of drains. The author provides a brief literature review on this subject and comments on the work carried out by Wen et al., analyzing divergences between literature data and those presented by Wen et al., and trying to identify the causes of low adherence to the evaluated technique.

Shoulder amplitude movement does not influence postoperative wound complications after breast cancer surgery: a randomized clinical trial.

PURPOSE: The goal of this study is to evaluate the influence of shoulder exercises with restricted amplitude movement (RAM) or free amplitude movement (FAM) performed from the first postoperative day (1st POD) on the incidence of surgical wound complications (SWC) in breast cancer. METHODS: This study comprises a randomized clinical trial with an intention-to-treat analysis including 465 women aged 18 to 79, who underwent curative surgery for breast cancer. Participants were submitted to perform free amplitude movement (FAM) or restricted amplitude movement (RAM) shoulder exercises, until the 30th postoperative day. The outcome measures were the SWC: seroma, dehiscence, necrosis, infection, hematoma and bruise. RESULTS: 461 participants completed the follow-up. Thirty days after surgery, 63.8% of the women presented some surgical wound complication, with necrosis (39.3%) and seroma (30.8%) as the most frequent. No statistically significant differences in SWC according to postoperative amplitude shoulder exercise (FAM vs RAM), even after a stratified analysis by type of surgery (segmentectomy vs mastectomy) or axillary approach (axillary lymphadenectomy versus sentinel lymph node biopsy) were observed. CONCLUSION: FAM exercises do not increase the incidence of postoperative wound complications compared to RAM exercises. TRIAL REGISTRATION: NCT03796845.

Alcohol consumption does not increase the risk of surgical wound complications in breast cancer patients.

Alcohol consumption, despite influencing several organic processes, has been scarcely studied regarding the risk of developing surgical wound complications after surgical breast cancer treatment. The aim of this study was to analyse the association between alcohol consumption and the development of surgical wound complications in women undergoing surgical treatment for breast cancer. A prospective cohort study was conducted, comprising 486 women between 40 and 69 years old, interviewed during the preoperative period and followed up for 30 days. The occurrence of seroma, necrosis, surgical site infection (SSI), dehiscence, ecchymosis, and hematoma were considered as outcomes. Alcohol consumption during the 30 days prior to surgery was reported by 20.8% of the patients, with 8.4% being occasional consumers and 12.4% regular consumers. Binge drinking was reported by 10.2% of the women. The presence of surgical wound complications was observed in 65.2%. The most frequent complications were seroma (54.3%), necrosis (17.7%), and SSI (7.8%). No statistically significant association between alcohol consumption and the development of cicatricial complications was observed.

[Comparación entre ligadura con lazo hemostático y engrapadora mecánica lineal para el cierre de base apendicular]. / Comparison between endoloop and linear mechanical stapler for the appendicular stump closure.

INTRODUCCIÓN: En las últimas décadas es creciente el abordaje por mínima invasión de patologías abdominales debido a sus beneficios evidentes. El cuadro apendicular es la principal emergencia quirúrgica, con diferentes métodos del cierre de la base apendicular. En este artículo comparamos dicho cierre con engrapadora lineal o ligadura con lazo hemostático, para analizar la frecuencia de complicaciones como absceso, dehiscencia y seroma. MÉTODO: Se realizó un estudio prospectivo, observacional y descriptivo, con un total de 703 procedimientos, empleando en 567 pacientes ligadura con lazo hemostático y en 136 engrapadora lineal, operados por los mismos cirujano y equipo quirúrgico, con curva de aprendizaje concluida. RESULTADOS: Las complicaciones referidas en el presente estudio son absceso (n = 5), dehiscencia (n = 3) y seroma (n = 3). De acuerdo con las fases de la patología apendicular: fase 1 o apéndice congestivo, no presentaron complicaciones; fase 2 o supurativo, se reportó un caso de dehiscencia de herida quirúrgica con el uso de ligadura con lazo hemostático; fase 3 o necrótico, se reportó un caso de seroma en un paciente tratado con ligadura con lazo hemostático; y fase 4 o perforado, se encuentra diferencia significativa en el caso de abscesos, reportando cinco con el uso de ligadura con lazo hemostático y ninguno con engrapadora lineal. CONCLUSIONES: En nuestro estudio no existe diferencia estadísticamente significativa entre el uso de engrapadora lineal o ligadura con lazo hemostático en las fases apendiculares 1-3; en la fase 4 es de utilidad significativa el uso de engrapadora lineal ante la incidencia de abscesos. INTRODUCTION: In the last decades, the approach by minimally invasive surgery of abdominal pathologies is growing due to its evident benefits; the appendicular cases being the main surgical emergency, with different methods of closing the appendicular base. In this article, we compared the appendicular base closure with linear stapler and endoloop, to analyze the frequency of complications such as abscess, dehiscence and seroma. METHOD: A prospective, observational and descriptive study was conducted, with a total of 703 procedures, using 567 endoloop patients and 136 linear stapler, operated by the same surgeon and surgical team, with a completed learning curve. RESULTS: The complications referred in the present study were patients with abscess (n = 5), dehiscence (n = 3) and seroma (n = 3). According to the phases of the appendiceal pathology: phase 1 or congestive appendix did not present complications; phase 2 or suppurative was reported one case of surgical wound dehiscence in the use of endoloop; in phase 3 or necrotic, one case of seroma was reported in a patient treated with endoloop; while in phase 4 or perforated there is a significant difference in the case of abscesses, reporting five in the use of endoloop and none in the case of a linear stapler. CONCLUSIONS: In our study there is no statistically significant difference between the use of linear stapler or endoloop in the early appendicular phases; being of significant utility in Phase 4 the use of linear stapler for the incidence of abscesses.

Efficacy of Drainless Total Thyroidectomy in Intrathyroidal Lesions of Thyroid

Abstract Introduction There is difference of opinion about the placement of the drain in thyroid surgeries, and, to the best of our knowledge, the efficacy of drainless total thyroidectomy regarding various parameters of thyroid lesions has not been well-established. Objective To report our experience with drainless total thyroidectomy, and to define an appropriate patient population for its performance. Methods This is a retrospective case analysis of the patients who underwent total thyroidectomy for intrathyroidal lesions with or without central neck dissection in a tertiary referral hospital (number = 74). The patients, who had undergone total thyroidectomy without any drain insertion, were analyzed, and the relationships among various parameters of thyroid lesions were noted in relation to seroma and hematoma formation. Results Seroma formation was noted only in 5 out of 74 patents (6.75%). All of the seromas that occurred were observed in patients with thyroid lesions < 4 cm, and 4 out of 5 seromas were observed in patients with a malignant pathology. There was no statistically significant difference in seroma formation between patients younger or older than 50 years of age. The nature of the lesion, whether benign or malignant, did not affect the formation of seroma. Of interest is the fact that none of the 10 patients who had central neck dissection performed as part of their treatment developed seroma. Conclusions Drainless total thyroidectomy is safe across all age groups for patients harboring either benign or malignant thyroid pathologies. However, caution is to be observed in opting for drainless total thyroidectomy in patients with large lesions (> 5 cm)

Endoscopic subcutaneous component separation as an adjunct to abdominal wall reconstruction.

BACKGROUND: Proper defect closure during abdominal wall reconstruction (AWR) is a key to improving cosmetic and functional results, and reducing morbidity. We have completed the initial prospective evaluation of a technique we previously described and published: endoscopic subcutaneous anterior component separation (ACS) as an adjunct to mainly laparoscopic AWR. We now present the long-term clinical and imaging follow-up results. STUDY DESIGN: Data were prospectively collected over a 3-year period (2012-2015) on patients who underwent AWR with endoscopic ACS. Inclusion criteria included the following: defects of 6-15 cm that are longer than wider; no skin dystrophy; no loss of domain; no active infection; no previous multiple, complex repairs; no previous multiple mesh repairs; and no high probability of severe adhesions. All patients were followed up clinically at 3, 6, and 12 months postoperatively and then annually. All patients underwent CT scanning of the abdominal wall (sagittal, axial, coronal, and 3D reconstruction) at 3 months and 1 year postoperatively and then annually. RESULTS: Twenty consecutive patients underwent adjunctive endoscopic ACS: 17 laparoscopic AWRs, 2 open repairs, and 1 hybrid repair. Up to 38 months (mean 21 months) of follow-up, there were no ventral hernia recurrences or de novo hernias at the ACS site. One patient experienced partial primary closure failure. Morbidity consisted in one case each of hematoma, seroma, and transient neuralgia. Cosmetic results and patient satisfaction were excellent. CONCLUSION: We confirmed that endoscopic subcutaneous ACS is a safe, effective, reliable, reproducible technique that facilitates primary closure of defects during AWR in selected patients.

Seroma and quilting suture at the donor site of the TRAM flap in breast reconstruction: a prospective randomized double-blind clinical trial.

Seroma formation at the donor site of the transverse rectus abdominis myocutaneous flap was evaluated in 48 patients who underwent breast reconstruction with either quilting sutures and suction drains (QS+DN group) or quilting sutures alone (QS group) or suction drains alone (DN group). Clinical and ultrasound examinations were performed to assess seroma formation in 5 regions of the abdominal wall on postoperative days 7 and 14. The incidence of seroma detected by ultrasound examination was significantly higher in the DN group (P = 0.008) than that in the other 2 groups. No difference in seroma volume (puncture) was found between the QS+DN and QS groups (P = 1.00). Seroma formation was observed in the iliac region in the DN group but not in the QS+DN and QS groups (P = 0.028). Quilting sutures at the transverse rectus abdominis myocutaneous flap donor site were efficient in reducing seroma formation.

Early hospital discharge following breast cancer surgery in the West Indies: a Trinidad study.

PURPOSE: To examine the outcome of a policy of early hospital discharge (<24 hours) after breast cancer surgery in a Third World setting, where health care resources and support services are very limited. DESIGN: Prospective enrollment into a plan of early hospital discharge within 24 hours following breast surgery. Followup was conducted for wound infections; seroma formation; flap dehiscence; and readmission, if any. SUBJECTS: All patients over a 15-year period who underwent wide local excision or mastectomy and axillary clearance were enrolled. RESULTS: A total of 331 patients were entered into the study. Of these, 148 had modified radical mastectomy and 183 had wide local excision plus axillary dissection. Each patient had a drain placed and output was recorded. Follow-up revealed that there was no increase in the complication rates. CONCLUSION: Early hospital discharge following breast cancer surgery is a feasible option for most patients and can be safely implemented even in a resource-limited setting where cost containment is essential.

Triple suture for neck contouring: 14 years of experience.

BACKGROUND: Preferred techniques for rejuvenation and contouring of the neck region have evolved over the past 40 years. A slender neckline is recognized as an attractive feature of youth, whereas aging of the lower face often includes ptosis of the soft tissues of the chin and banding or cording of the muscles of the anterior and lateral neck. Aesthetic rejuvenation of the face and neck involves repositioning of poorly supported soft tissues. OBJECTIVES: The authors review their 14-year experience with a technique incorporating standard submental liposuction with a method of triple suturing the medial platysmal bands associated with lateral plication of the superficial muscular aponeurotic system (SMAS)-platysma. METHODS: Between 1994 and 2008, 507 patients (451 women and 56 men) were treated with this technique which consisted of placing a first line of sutures distributing tension between the medial platysmal bands and the anterior belly of the digastric muscles, a second single suture at the distal medial borders of the platysma, and a third running suture starting at the level of the thyroid cartilage up to the supramental region. In most cases, a lateral plication of the SMAS-platysma and a "stair-like" SMAS plication were performed in order to define the cervicomandibular line and treat midface flaccidity, respectively. RESULTS: Mean follow-up was eight years. Complications included hematomas (4.6%) and seromas (3.6%). Four percent of patients underwent a second procedure approximately seven years after their primary procedure. Overall the majority of patients exhibited long-lasting results satisfactory to both patients and surgeons. CONCLUSION: The triple-suture technique for neck contouring creates a median vertical vector of traction, whereas lateral plication produces a lateral posterior oblique vector. The combination of these two procedures is an easily reproducible and reliable option for surgeons when patients are seeking a more youthful appearance of the neck.

Liposuction: 25 years of experience in 26,259 patients using different devices.

BACKGROUND: The development of liposuction provided plastic surgeons with a safe and effective way to sculpt the human figure. The techniques and instrumentation used in the performance of liposuction have evolved significantly since its introduction. OBJECTIVE: The authors review their experience with different liposuction techniques over the past 25 years. METHODS: Data from patients who had undergone liposuction were collected from the personal databases of four different surgeons and from the database at the Corpus and Rostrum Plastic Surgery Clinic in Cali, Colombia. A retrospective review was conducted and the results from different liposuction techniques were compared. RESULTS: A total of 26,259 patient charts were reviewed. The results showed that 5% of patients experienced a postsurgical seroma. Postsurgical fibrosis developed to some degree in 2.3% of patients. Anemia was present in 18% of all patients and in 60% of those patients who underwent dry liposuction. Ninety percent of patients reported postoperative pain. The incidence of deep vein thrombosis was 0.03%, as was the incidence of pulmonary embolism. Mortality was 0.01% and was mainly caused by pulmonary embolism. Patient satisfaction was similar for all of the described techniques. CONCLUSIONS: The incidence of anemia was reduced significantly in patients undergoing tumescent liposuction versus dry liposuction. However, the occurrence of seroma increased with the introduction of tumescent liposuction. The incidence of postoperative pain and fibrosis was similar for all liposuction techniques reviewed. The aesthetic results obtained using ultrasound- or laser-assisted liposuction were similar to those obtaining using other techniques.

Placa axilar compresiva fija para prevenir el seroma persistente postlinfadenectomía: comparación con controles históricos / Compressive axillary plates for persistent seroma after axillary lymphadenectomy

El seroma axilar persistente postlinfadenectomía es una complicación frecuente de la cirugía del cáncer mamario infiltrante, describiéndose diversas técnicas para su control. Para evaluar el beneficio adicional con el uso de placas axilares compresivas fijas se comparó una serie retrospectiva de 30 pacientes en que se usó este dispositivo con una serie histórica seleccionada aleatoriamente y manejada con un tratamiento estándar que consistió en el uso de drenajes aspirativos y compresión axilar con venda elástica. Los dos grupos resultaron homogéneos en las variables edad, estadio clínico y tipo de operación. La serie histórica tuvo una incidencia de seroma persistente de 26,67 por ciento (8/30), mientras que en el grupo con placa fue de un 6,67 por ciento (2/30), diferencia que fue estadísticamente significativa. Concomitantemente, el grupo con placa tuvo una duración del uso de los drenajes significativamente menor. No hubo diferencias en la duración del seroma ni en la aparición de complicaciones locales. No observamos ninguna relación entre la aparición de seroma y la utilización de alguna técnica quirúrgica en particular o de radioterapia preoperatoria.

Background: Persistent axillary post-lymphadenectomy seroma is a frequent complication of breast cancer treatment. Aim: To evaluate the benefit of fixed compressive axillary plates for this complication. Material and methods: Retrospective comparison of 30 patients in whom this technique was used with a randomized historic group of 30 women, handled with a standard technique that included suction drains and external axillary compressive elastic bandages. Results: Both groups had similar age, stage and operation type. Eight patients (27 percent) in the historic group and 2 (7 percent) in the axillary plate group had a persistent axillary seroma (p=0.04). Additionally, the plate group needed drains for a shorter period. There were no differences in the duration of seroma and the appearance of local complications. We did not observe any relationship between seroma appearance and the use of any particular operative technique or preoperative radiotherapy use. Conclusions: The use of fixed compressive axillary plates reduced the incidence of persistent seroma after axillary lymphadenectomy.

[Frequency of postoperative seromas in mastectomy wounds with the use of one or two drainages: a pilot study]. / Estudio piloto: frecuencia de seromas postoperatorios en heridas de mastectomia con el uso de uno o dos drenajes.

OBJECTIVE: To compare the number of postoperative seromas after mastectomy with the use of one or two drainages. PATIENTS AND METHODS: Women with malignant tumors who underwent Madden modified radical mastectomy were studied. They were divided into two groups: group A two drainages (axillar and pectoral), group B only one (axillar). For both groups demographical issues, body mass index (BMI = kg/m2), seromas and drainage period were determined. RESULTS: Twenty seven patients were evaluated: group A composed of 12 patients and B composed of 15. Age (years): A 56 +/- 14 vs B 50 +/- 6.5 (p NS), BMI: A 33.2 +/- 3.4 vs B 32.6 +/- 4.5 (p NS); seromas: A 4 vs B 5 (p NS); drainage period: A 23 +/- 6 vs B 24 +/- 7 (p NS). CONCLUSIONS: There are no differences in postoperative seroma development in mastectomy wounds with the use of one or two drainages.

Postoperative complications of thyroidectomy for differentiated thyroid carcinoma.

OBJECTIVE: This study evaluates the incidence and risk factors of complications in patients submitted to thyroidectomy for differentiated thyroid carcinoma in a cancer hospital with residency training. STUDY DESIGN: A retrospective chart and complications review of 316 consecutive patients who underwent thyroidectomy for differentiated thyroid carcinoma. RESULTS: Of the 316 patients, the main postoperative complications were transient hypocalcemia in 87 (27.5%), permanent hypocalcemia in 16 (5.1%), transient vocal cord palsy in 4 (1.2%), and permanent vocal cord palsy in 2 (0.6%). Neck dissection and paratracheal lymph node dissection when associated with total thyroidectomy were significantly related to transitory and permanent hypocalcemia. CONCLUSION: Thyroid surgery can be performed safely in a hospital with medical residency training program under direct supervision of an experienced surgeon with acceptable morbidity. Hypocalcemia is the most significant complication. Neck and paratracheal lymph node dissections were the most significant predictors of hypocalcemia in patients submitted to total thyroidectomy.