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Prevalence, Risk Factors, and Management of Seroma Formation After Breast Approach Endoscopic Thyroidectomy

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Abstract

Background

Breast approach endoscopic thyroidectomy (BAET) allows surgeons to remove a thyroid tumor from a remote site while providing a scarless cosmetic appearance in the neck. However, seroma formation after subcutaneous dissection could lead to flap detachment, incision dehiscence, and wound infection. Chronic formation of seromas could substantially compromise the esthetic outcome of BAET. We evaluated the prevalence, risk factors, and treatments of seroma after BAET.

Methods

A total of 344 patients who underwent BAET between 2001 and 2008 at our institution were recruited; data were collected prospectively. The characteristics and outcomes of patients who developed seromas were compared with those of patients who did not. Regression analysis was used to identify the independent risk factors for seroma formation. The frequency and volume of aspirations were noted until the seroma went into remission.

Results

The overall postoperative prevalence of seroma formation was 2.9%. There was a significant difference in seroma formation based on age, hypertension, body mass index (BMI), and area of subcutaneous dissection space (ASDS). Percutaneous aspiration alone or combined with external compression was extremely effective. The frequency and total volume of aspirations were 1–7 and 6–120 ml, respectively. As a result of prolonged seroma formation, one patient developed an expanding pseudo-bursa that created a tumor-like effect in the anterior chest wall.

Conclusions

Seroma formation was an uncommon minor complication after BAET. Four independent etiologic factors could predispose patients to postoperative seroma formation. Percutaneous aspiration appeared to be very effective. Prolonged seroma formation followed by development of a pseudo-bursa could be very problematic and could substantially impair the esthetic effect of BAET.

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References

  1. Tan CTK, Cheah WK, Delbridge L (2008) “Scarless” (in the neck) endoscopic thyroidectomy (SET): an evidence-based review of published techniques. World J Surg 32:1349–1357

    Article  PubMed  Google Scholar 

  2. Gagner M (1996) Endoscopic subtotal parathyroidectomy in patients with primary hyperparathyroidism. Br J Surg 83:875

    Article  CAS  PubMed  Google Scholar 

  3. Ikeda Y, Takami H, Sasaki Y et al (2000) Endoscopic neck surgery by the axillary approach. J Am Coll Surg 191:336–340

    Article  CAS  PubMed  Google Scholar 

  4. Ohgami M, Ishii S, Arisawa Y et al (2000) Scarless endoscopic thyroidectomy: breast approach for better cosmesis. Surg Laparosc Endosc Percutan Tech 10:1–4

    CAS  PubMed  Google Scholar 

  5. Kuroi K, Shimozuma K, Taguchi T et al (2005) Pathophysiology of seroma in breast cancer. Breast Cancer 12:288–293

    Article  PubMed  Google Scholar 

  6. Unalp HR, Onal MA (2007) Analysis of risk factors affecting the development of seromas following breast cancer surgeries: seromas following breast cancer surgeries. Breast J 6:588–592

    Article  Google Scholar 

  7. Ovens L, Pickford MA (2009) Effect of quilting sutures on seroma formation post-abdominoplasty. Eur J Plast Surg 32:177–180

    Article  Google Scholar 

  8. Gonzalez EA, Saltzstein EC, Riedner CS (2003) Seroma formation following breast cancer surgery. Breast J 5:385–388

    Article  Google Scholar 

  9. Cihan A, Ozdemir H, Ucan BH et al (2006) Fade or fate, seroma in laparoscopic inguinal hernia repair. Surg Endosc 20:325–328

    Article  CAS  PubMed  Google Scholar 

  10. Slotema ET, Sebag F, Henry JF (2008) What is the evidence for endoscopic thyroidectomy in the management of benign thyroid disease? World J Surg 32:1325–1332

    Article  PubMed  Google Scholar 

  11. Anand R, Skinner R, Dennison G et al (2002) A prospective randomized trial of two treatments for wound seroma after breast surgery. Eur J Surg Oncol 28:620–622

    Article  CAS  PubMed  Google Scholar 

  12. Ikeda Y, Takami H, Sasaki Y et al (2002) Comparative study of thyroidectomise: endoscopic surgery versus conventional open surgery. Surg Endosc 16:1741–1745

    Article  CAS  PubMed  Google Scholar 

  13. Sanabria A, Carvalho AL, Silver CE et al (2007) Routine drainage after thyroid surgery—a meta-analysis. J Surg Oncol 96:273–280

    Article  PubMed  Google Scholar 

  14. Lau H, Lee F (2003) Seroma following endoscopic extraperitoneal inguinal hernioplasty: incidence and risk factors. Surg Endosc 17:1773–1777

    Article  CAS  PubMed  Google Scholar 

  15. Dauria DM, Dyk P, Garvin P (2006) Incidence and management of seroma after arteriovenous graft placement. J Am Coll Surg 203:506–511

    Article  PubMed  Google Scholar 

  16. Loo WTY, Chow LWC (2007) Factors predicting seroma formation after mastectomy for Chinese breast cancer patients. Indian J Cancer 44:99–103

    Article  PubMed  Google Scholar 

  17. Kumar S, Lal B, Misra MC (1995) Post-mastectomy seroma: a new look into the aetiology of an old problem. J R Coll Surg Edinb 40:292–294

    CAS  PubMed  Google Scholar 

  18. Sasaki A, Nakajima J, Ikeda K et al (2008) Endoscopic thyroidectomy by the breast approach: a single institution’s 9-year experience. World J Surg 32:381–385

    Article  PubMed  Google Scholar 

  19. Liu S, Qiu M, Jiang DZ et al (2009) The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc 23:1803–1806

    Article  Google Scholar 

  20. Kuroi K, Shimozuma K, Taguchi E et al (2006) Effect of mechanical closure of dead space on seroma formation after breast surgery. Breast Cancer 3:260–265

    Article  Google Scholar 

  21. Benjasirichai V, Piyapant A, Pokawattana C (2007) Reducing postoperative seroma by closing of axillary space. J Med Assoc Thai 11:2321–2324

    Google Scholar 

  22. Susmallian S, Gewurtz G, Ezri T et al (2001) Seroma after laparoscopic repair of hernia with PTFE patch: is it really a complication? Hernia 5:139–141

    Article  CAS  PubMed  Google Scholar 

  23. Jain PK, Sowdi R, Anderson AD et al (2004) Randomized clinical trial investigating the use of drains and fibrin sealant following surgery for breast cancer. Br J Surg 91:54–60

    Article  CAS  PubMed  Google Scholar 

  24. Kopelman D, Klemm O, Bahous H et al (1999) Postoperative suction drainage of the axilla: for how long? Prospective randomised trial. Eur J Surg 165:117–120

    Article  CAS  PubMed  Google Scholar 

  25. Dalberg K, Johansson H, Signomklao T et al (2004) A randomised study of axillary drainage and pectoral fascia preservation after mastectomy for breast cancer. Eur J Surg Oncol 30:602–609

    Article  CAS  PubMed  Google Scholar 

  26. Cameron AE, Ebbs SR, Wylie F et al (1988) Suction drainage of the axilla: a prospective randomized trial. Br J Surg 75:1211

    Article  CAS  PubMed  Google Scholar 

  27. Zavotsky J, Jones RC, Brennan MB et al (1998) Evaluation of axillary lymphadenectomy without axillary drainage for patients undergoing breast-conserving therapy. Ann Surg Oncol 5:227–231

    Article  CAS  PubMed  Google Scholar 

  28. Baas-Vrancken Peeters MJ, Kluit AB, Merkus JW et al (2005) Short versus long term postoperative drainage of the axilla after axillary lymph node dissection. A prospective randomized study. Breast Cancer Res Treat 93:271–275

    Article  PubMed  Google Scholar 

  29. Agrawal A, Ayantunde AA, Cheung KL (2006) Concepts of seroma formation and prevention in breast cancer surgery. ANZ J Surg 76:1088–1095

    Article  PubMed  Google Scholar 

  30. Roje Z, Roje Z, Karanovic N et al (2006) Abdominoplasty complications: a comprehensive approach for the treatment of chronic seroma with pseudo bursa. Aesth Plast Surg 5:611–615

    Article  Google Scholar 

  31. Stanczyk M, Grala B, Zwierowicz T et al (2007) Surgical resection for persistent seroma, following modified radical mastectomy. World J Surg Oncol 5:104–108

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Minimally Invasive Surgery, Chang Zheng Hospital Affiliated to Second Military Medical University, No. 415 Fengyang Road, Shanghai, 200003, China

    Cheng-Xiang Shan, Wei Zhang, Dao-Zhen Jiang, Xiang-Min Zheng, Sheng Liu & Ming Qiu

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  1. Cheng-Xiang Shan
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  2. Wei Zhang
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  3. Dao-Zhen Jiang
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  4. Xiang-Min Zheng
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  5. Sheng Liu
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  6. Ming Qiu
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Corresponding author

Correspondence to Ming Qiu.

Additional information

Cheng-Xiang Shan and Wei Zhang contributed equally to this work.

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Shan, CX., Zhang, W., Jiang, DZ. et al. Prevalence, Risk Factors, and Management of Seroma Formation After Breast Approach Endoscopic Thyroidectomy. World J Surg 34, 1817–1822 (2010). https://doi.org/10.1007/s00268-010-0597-y

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  • DOI: https://doi.org/10.1007/s00268-010-0597-y

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