Suction versus siphon drainage after axillary surgery for breast cancer: A prospective randomized trial

Abstract

ReferencesClosed suction drainage is beneficial in reducing the incidence of axillary seroma following breast surgery'-3. The incidence of postoperative seroma formation is less when the volume drained is under 30 ml per 24 h but to achieve this4 drains occasionally need to remain in situ for more than 10 days. Suction drainage may encourage continued lymphatic flow by virtue of a negative pressure effect. The present prospective study examined this hypothesis by comparing the duration and volume of drainage from a suction drain with that from a siphon drain. Patients and methodsAll women with breast cancer undergoing axillary dissection between September 1991 and April 1992 were included in the study. The axilla was approached through a mastectomy incision or a separate axillary incision and level 1 axillary dissection performed. After haemostasis had been achieved, each patient was randomized by sealed envelopes to receive a closed siphon drain (2CFr Robinson; H. G. Wallace, Colchester, UK) or -750 mmHg suction drain (10-Fr Medinorm S600;Medinorm, Abnieuwegein, The Netherlands). After placement of the drain the wound was closed and further diathermy prohibited. A record of drainage volume was kept and drains removed when this was less than 30 ml per 24 h. At 5 days after drain removal, or earlier if symptomatic, the wound was examined for signs of infection and seroma formation. Seroma was defined as any fluctuant fluid collection. All collections were aspirated, with reaspiration 72 h later if indicated. Data concerning the incidence of late complications were not collected. Statistical analysis was performed using Student's t test. ResultsFifty-one patients htially entered the study; one declined to consent to randomization and was excluded. The two groups Paper accepted 3 September 1993 were matched for age, weight, number of nodes excised, frequency of axillary pathology, perioperative tamoxifen administration and type of surgical procedure. The results are shown in Table 1. DiscussionThe need for axillary drainage after radical dissection is undisputed. This study shows that siphon and suction techniques are associated with a similar duration of drainage. Siphon drainage resulted in lower daily and total fluid losses but this was not at the expense of higher seroma or wound infection rates.The siphon drain is simple in design, easy to use and difficult to disrupt. Patients may leave hospital early with a drain in situ, recording daily volumes before returning for drain removal when appropriate. Unlike the siphon device, a suction drain may lose vacuum (occurring in one-third of the present patients; Table I), which may reduce efficiency.The performance of a siphon drain is comparable to that of a suction drain without the associated risk of vacuum loss. ReferencesCameron AEP, Ebbs SR, Wylie F, Baum M.

Concepts of Seroma Formation and Prevention in Breast Cancer Surgery

“…Suction drain is known to obliterate the dead space left after breast surgery for cancer thereby preventing accumulation of seroma 72–77,85,90 . However, the incidence of seroma formation has been found to be higher when suction drains were used compared with passive drains, 77,78 whereas some other investigators reported no significant difference correlating to the rate of seroma between the two types of drains 79,85 . In contrast, the incidence of seroma was unacceptably high when suction drains were not used in a study by Kopelman et al 90…”

“…The influence of negative pressure causing skin flap apposition to the chest wall may facilitate wound healing, reduce the incidence of wound infection, wound dehiscence or flap necrosis and prevent seroma formation 44,75,76 . There are, however, controversies correlating to the optimal suction pressure, number of drains, duration of drainage or in fact whether the drain should be used at all following breast cancer surgery 20,74,76–80 …”

“…Drain continues to be used after breast excision and axillary dissection in spite of the fact that there is no clear evidence that it totally reduces the incidence of seroma formation 79–81 . There are authors who do not insert drain after breast cancer surgery because of the belief that it does not prevent seroma formation and is associated with increased wound complications, patient’s discomfort and prolongs hospital care 74,75,82–89 .…”

Seroma Formation after Breast Cancer Surgery: What We Have Learned in the Last Two Decades

“…A study by Bourke et al [77] found no difference between using closed suction wound drainage and corrugated wound drainage in 51 patients who underwent simple mastectomy [78]. In a study by Whitfield and Rainsbury [79], no significant difference was observed between suction and closed siphon drainage on the formation of seroma. The choice of the number of drain tubes used has been studied.…”

Prise en charge des lymphocèles après curage axillaire dans le cancer du sein

“…Il permet en outre d'augmenter la liberté de mouvement et de diminuer l'inconfort des patientes opérées [42,43]. Il est devenu un standard de la prise en charge postopératoire du CA [44], même si aujourd'hui encore, son efficacité sur la diminution de la formation des séromes est discutée [45,46]. L'intensité de l'aspiration ne paraît pas non plus avoir d'incidence sur la formation de séromes.…”