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Background and Objectives Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy. Methods A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed. Results Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024–11.060]). Conclusions Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. © 2016 Wiley Periodicals, Inc.

Resumen Introduccion El abordaje laparoscopico de la via biliar (ALVB) es una tecnica segura, reproducible y coste-efectiva para el tratamiento de la coledocolitiasis frente a la cirugia abierta. Tras la realizacion de la coledocotomia han sido propuestas diversas tecnicas para el cierre de la via biliar principal (VBP). Objetivo Presentar nuestra experiencia en el ALVB como tecnica rutinaria en el tratamiento de la coledocolitiasis y las lecciones aprendidas tras mas de 200 casos. Pacientes y metodos Entre enero de 1999 y julio de 2012 se realizo el ALVB en 206 pacientes con el diagnostico de coledocolitiasis. En los inicios de la serie realizamos el cierre de la via biliar (VB) mediante tubo de Kehr, posteriormente la tecnica de eleccion fue la colocacion de un stent anterogrado, pero dada la elevada incidencia de pancreatitis aguda (PA), en los ultimos pacientes de la serie realizamos un cierre primario de la VBP sin drenaje de la misma. Resultados Los grupos fueron homogeneos en cuanto a edad y sexo. La presentacion clinica mas frecuente fue la ictericia. En 185 pacientes (88,5%) se realizo un abordaje quirurgico mediante coledocotomia y en 17 pacientes (8,7%), transcistico. En los pacientes a los que se realizo coledocotomia, el tamano medio de las litiasis fue mayor (9,7 vs. 7,6 mm en el abordaje transcistico). Tras la coledocotomia colocamos un tubo de Kehr para el cierre de la VBP en 36 pacientes, en 133 se coloco un stent anterogrado observando un 11,6% de PA y un 26,1% de hiperamilasemia, por lo que en los ultimos pacientes de la serie (16) hemos realizado un cierre primario de la VBP sin drenaje, mejorando la morbilidad y la estancia hospitalaria. Se observo una disminucion de la morbimortalidad en pacientes menores de 75 anos y en el grupo de pacientes en los que existia una mayor experiencia por parte del cirujano. Conclusiones Tras la realizacion del ALVB en el tratamiento de la coledocolitiasis, un cierre primario de la VB sin drenaje de la misma presenta ventajas sobre otras tecnicas mas clasicas como la colocacion de un tubo de Kehr o el stent. Es importante una adecuada curva de aprendizaje para mejorar los resultados en el manejo laparoscopico de esta enfermedad. El ALVB es una tecnica segura y reproducible, especialmente en pacientes menores de 75 anos.

Postoperative seroma after axillary lymphadenectomy leads to an increased use of resources and an impaired quality of life of patients. This randomized clinical trial was designed to assess the value of a hemostatic and sealing agent for decreasing seroma occurrence after axillary lymphadenectomy.A prospective, randomized, blind study was conducted on 91 axillary lymphadenectomies distributed into a control group (n = 47) and a test group in which a collagen sponge coated with human coagulation factors was used (n = 44). Primary end-points were number of days before removal of axillary drainage, axillary drainage output, and occurrence of seroma, wound infection, haematoma, or wound dehiscence, within 8 weeks of surgery. Bivariate and multivariate analyses on seroma occurrence were performed.Seroma occurred in 29 patients (31.86%). A significant direct relationship (P = 0.002) was only noted between use of the hemostatic and sealing agent and nonoccurrence of seroma. In the multivariate study, the only variable found to be significantly related to seroma occurrence was use of the above agent (P = 0.046; odds ratio: 3.365 [95%CI: 1.024-11.060]).Use of a collagen sponge coated with human coagulation factors following axillary lymphadenectomy was associated to a lower incidence of postoperative seroma. J. Surg. Oncol. 2016;114:423-427. © 2016 Wiley Periodicals, Inc.

Introduction Laparoscopic common bile duct exploration (LCBDE) is a reliable, reproducible and cost-effective treatment for common bile duct stones. Several techniques have been described for choledochotomy closure. Aims To present our experience and the lessons learned from more than 200 cases of LCBDE. Patients and methods Between January 1999 and July 2012, 206 patients with common bile duct stones underwent LCBDE. At the beginning of the series, we performed the closure of the CBD over a T-tube (36 patients), subsequently we favoured closure over an antegrade stent (133 patients), but due to a high incidence of acute pancreatitis in the last 16 patients we have performed primary closure. Results The 3 closure groups were matched for age and sex. Jaundice was the most frequent presentation. A total of 185 (88.5%) patients underwent choledochotomy, whereas in 17 (8.7%) patients the transcystic route was used. The group that underwent choledochotomy had a larger size of stones compared to the transcystic group (9.7 vs 7.6 mm). In the stented group we found an 11.6% incidence of pancreatitis and a 26.1% incidence of hyperamylasemia. In the primary closure group we found a clear improvement of complications and hospital stay. The increased experience of the surgeon and age (younger than 75) had a positive impact on mortality and morbidity. Conclusions Primary closure of the common bile duct after LCBDE seems to be superior to closure over a T tube and stents. The learning curve seems to have a positive impact on the outcomes, making it a safe and reproducible technique especially for patients aged under 75 years.