RESUMEN
BACKGROUND: Seroma is a common complication after mastectomy, with an incidence of 3% to 85%. Seroma is associated with pain, delayed wound healing, and additional outpatient clinic visits, leading potentially to repeated seroma aspiration or even surgical interventions. This study aimed to assess the effect of flap fixation using sutures or tissue glue in preventing seroma formation and its sequelae. METHODS: Between June 2014 and July 2018, 339 patients with an indication for mastectomy or modified radical mastectomy were enrolled in this randomized controlled trial in the Netherlands. Patients were randomly allocated to one of the three following arms: conventional wound closure (CON, n = 115), flap fixation using sutures (FFS, n = 111) or flap fixation using tissue glue (FFG, n = 113). The primary outcome was the need for seroma aspiration. The secondary outcomes were additional outpatient department visits, surgical-site infection, shoulder function and mobility, cosmesis, skin-dimpling, and postoperative pain scores. RESULTS: Flap fixation after mastectomy leads to fewer seroma aspirations than conventional wound closure (CON 17.5% vs FFS 7.3% vs FFG 10.8%; p = 0.057), with a significant difference between flap fixation with sutures and conventional wound closure (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.16-0.89; p = 0.025). Flap fixation has no significant negative effect on surgical-site infections, shoulder function and mobility, cosmesis, skin-dimpling, or postoperative pain. CONCLUSION: Flap fixation using sutures leads to a significant reduction in aspirations of post-mastectomy seromas. The authors strongly advise surgeons to use sutures for flap fixation in patients undergoing mastectomy. (ClinicalTrials.gov no. NCT03305757). PREREGISTRATION: The trial was registered after enrollment of the first participant. However, no specific explanation exists for this except that through the years more importance has been given to central trial registration. Our research team can ensure that after enrollment of the first participant, no changes were made to the trial, analysis plan, and/or study design.
Asunto(s)
Neoplasias de la Mama , Seroma , Neoplasias de la Mama/cirugía , Humanos , Mastectomía/efectos adversos , Países Bajos , Complicaciones Posoperatorias/prevención & control , Seroma/etiología , Seroma/prevención & control , Colgajos QuirúrgicosRESUMEN
OBJECTIVES: In follow up or primary analysis of malignant disease, use of nuclear medicine imaging techniques is increasing. The lesions, detected by these modalities, do not always present with a matching radiological abnormality suitable for radiological biopsy. A method to confirm, or rule out, metastatic disease in these cases is radionuclide-guided surgical biopsy. PATIENTS AND METHODS: The technique consists of injecting a Technetium-99m labelled diphosphonate, performing a bone scan and marking the lesion; under general anaesthetic a surgical biopsy is taken through a small incision guided by a gamma-probe. We evaluated the combined experience of two teaching hospitals, by conducting retrospective chart review, over a period of 5.5 years. Sixty-nine procedures with 79 biopsies were performed. The patients previously had breast cancer in 42%, lung cancer in 32%, both gastrointestinal and urological malignancies in 13%, miscellaneous or unknown origin were reported in 9%. In 68% a rib biopsy was taken, in 15% a pelvis biopsy and in 11% a sternum or clavicle biopsy. RESULTS: In 46.8% metastatic disease was confirmed and in 2.6% a new malignancy (M Kahler) was identified. During a median clinical follow up period of 31 months (1-70), 1 initially negative biopsy site was found to contain a metastasis. Apart from local pain in 3% of cases, no complications were mentioned. CONCLUSION: In conclusion we can state that, in this retrospective series, radionuclide-guided bone biopsy is a reliable, well-tolerated technique to determine the diagnosis of these lesions with a sensitivity of 97% and specificity of 100%.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias de la Mama/patología , Neoplasias Gastrointestinales/patología , Biopsia Guiada por Imagen/métodos , Neoplasias Pulmonares/patología , Neoplasias Urológicas/patología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/patología , Neoplasias Óseas/secundario , Clavícula/diagnóstico por imagen , Clavícula/patología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/patología , Cintigrafía , Estudios Retrospectivos , Costillas/diagnóstico por imagen , Costillas/patologíaRESUMEN
Two male patients presented to the surgical outpatient clinic with a paramedian abdominal bulge. In the first patient, the hardly known diagnosis linea arcuata hernia (LAH) had been missed at a previous exploration 8 years ago. In the second patient, pre-operative imaging showed an abdominal wall hernia. Diagnostic laparoscopy revealed an LAH. In both cases, the hernia was repaired with a mesh graft.
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Hernia Abdominal/diagnóstico , Hernia Abdominal/cirugía , Laparoscopía , Mallas Quirúrgicas , Adulto , Diagnóstico Diferencial , Humanos , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Rupture of a thoraco-abdominal aortic aneurysm (TAAA) is usually lethal. Patients with contained ruptures, who reach the hospital, have traditionally been subjected to open reconstructive surgery. However, especially in older patients, open surgery has a high mortality and morbidity rate. Visceral hybrid procedures (VHPs) can provide an alternative in this high-risk patient group. We present a literature review of VHPs with a focus on acute TAAAs.
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Aneurisma de la Aorta Torácica/cirugía , Rotura de la Aorta/cirugía , Procedimientos Quirúrgicos Vasculares , Enfermedad Aguda , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Aneurisma de la Aorta Torácica/mortalidad , Rotura de la Aorta/mortalidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selección de Paciente , Medición de Riesgo , Resultado del Tratamiento , Procedimientos Quirúrgicos Vasculares/efectos adversos , Procedimientos Quirúrgicos Vasculares/mortalidad , Adulto JovenRESUMEN
In a 59-year-old woman with pain in the right upper abdomen, echography and CT-scan revealed adenomatosis of the gallbladder. Her symptoms did not disappear after cholecystectomy, even though echography showed no further abnormality. In a 46-year-old man with fever and weight loss, echography revealed two polyps in the gallbladder. Following cholecystectomy, histopathology revealed cholesterol polyps and an infection with Entamoeba coli. In a 63-year-old man with systemic symptoms, a biopsy of the echographically diagnosed tumour of the gallbladder revealed that he had actually had cholecystitis. The management was wait-and-see and the patient recovered completely. In a 68-year-old woman with jaundice and attacks of abdominal pain, a CT-scan revealed gallstones. The symptoms recurred following an ERCP. Following cholecystectomy, an adenocarcinoma of the gallbladder was found. One year later, a contact metastasis developed forwhich she received radiotherapy. After 4 years she was in good condition. Patients with a tumour in the gallbladder are often diagnosed with gallbladder cancer, which has a poor prognosis. Other diseases should also be considered, since the treatment and prognosis differ greatly. It is important to differentiate at an early stage. Ultrasound, CT and MRI have improved the possibility of differentiating and choosing the correct treatment.