The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: A meta-analysis

Calpin, Gavin G.; McAnena, Peter; Davey, Matthew G.; Calpin, Pádraig; Kerin, Michael J.; McInerney, Niall; Walsh, Stewart R.; Lowery, Aoife

doi:10.1016/j.surge.2022.11.005

Cited by 12 publications

(9 citation statements)

References 52 publications

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“…With additional stratified analysis, we could further elucidate benefits of each specific administration modality and in various surgical cohorts compared with past reviews. 34,35 With the relatively small number of studies in the literature looking at TXA use in breast surgery, we feel that including all relevant studies with any use of TXA and of varying study design was important to obtain a larger sample. To address the variability, we performed subgroup analyses evaluating only topical TXA administration, IV TXA administration, and oncologic or nononcologic breast surgery.…”

Section: Discussionmentioning

confidence: 99%

“…By including studies with any use of either IV or topical TXA, we have the largest sample size to date compared with previous reviews and add to the growing body of evidence that TXA, both IV and topical, may significantly affect breast surgery outcomes. With additional stratified analysis, we could further elucidate benefits of each specific administration modality and in various surgical cohorts compared with past reviews 34,35 . With the relatively small number of studies in the literature looking at TXA use in breast surgery, we feel that including all relevant studies with any use of TXA and of varying study design was important to obtain a larger sample.…”

Section: Discussionmentioning

confidence: 99%

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Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

2023

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Background Topical and intravenous uses of tranexamic acid (TXA) have been shown to reduce bleeding and ecchymosis in various surgical fields. However, there is a lack of data evaluating the efficacy of TXA in breast surgery. This systematic review evaluates the impact of TXA on hematoma and seroma incidence in breast plastic surgery. Methods A systematic review of the literature was performed for all studies that evaluated the use of TXA in breast surgery including reduction mammoplasty, gynecomastia surgery, masculinizing chest surgery, or mastectomy. Outcomes of interest included rate of hematoma, seroma, and drain output. Results Thirteen studies met the inclusion criteria with a total of 3297 breasts, of which 1656 were treated with any TXA, 745 with topical TXA, and 1641 were controls. There was a statistically significant decrease in hematoma formation seen in patients who received any form of TXA compared with control (odds ratio [OR], 0.37; P < 0.001), and a similar tendency toward decreased hematoma with topically treated TXA (OR, 0.42; P = 0.06). There was no significant difference in seroma formation with any TXA (OR, 0.84; P = 0.33) or topical TXA (OR, 0.91; P = 0.70). When stratified by surgery, there was a 75% decrease in the odds of hematoma formation with any TXA compared with the control for oncologic mastectomy (OR, 0.25; P = 0.003) and a 56% decrease in nononcologic breast surgery (OR, 0.44; P = 0.003). Conclusions This review suggests that TXA may significantly reduce hematoma formation in breast surgery and may also decrease seroma and drain output. Future high-quality prospective studies are required to evaluate the utility of topical and intravenous TXA in decreasing hematoma, seroma, and drain output in breast surgery patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

2023

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“…In such patients, simple mastectomy is often performed. Simple mastectomy has several associated complications, with seroma formation being the most common 3 , 4 .…”

Section: Introductionmentioning

confidence: 99%

“…This is partly due to lymphatic vessels being cut during surgery, resulting in lymphatic fluid leakage and subsequent accumulation 5 , 6 . The current rate of seroma formation is estimated to be 15.0% 4 . Seroma formation can lead to a prolonged hospital stay, discomfort, and impaired wound healing, and can be a source of delay for adjuvant therapy, particularly radiotherapy 7–10 .…”

Section: Introductionmentioning

confidence: 99%

“…An electrothermal bipolar vessel-sealing system has been shown in some studies to decrease blood loss and drainage volume compared with electrocautery 13–17 . Other common complications after simple mastectomy include haematoma formation and surgical-site infection (rates of 0.6–7% and 5–6% respectively) 4 . Complications can also impact the length of time that postoperative drains remain in situ , reoperation rates, and postoperative pain, as well as contribute to delays in patients receiving adjuvant treatment.…”

Section: Introductionmentioning

confidence: 99%

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Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial

Keelan,

Dowling,

Roche

et al. 2024

British Journal of Surgery

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Background Electrosurgical devices are commonly used during mastectomy for simultaneous dissection and haemostasis, and can provide potential benefits regarding vessel and lymphatic ligation. The aim of this prospective RCT was to assess whether using a vessel-sealing device (LigaSure™) improves perioperative outcomes compared with monopolar diathermy when performing simple mastectomy. Methods Patients were recruited prospectively and randomized in a 1 : 1 manner to undergo simple mastectomy using either LigaSure™ or conventional monopolar diathermy at a single centre. The primary outcome was the number of days the drain remained in situ after surgery. Secondary outcomes of interest included operating time and complications. Results A total of 86 patients were recruited (42 were randomized to the monopolar diathermy group and 44 were randomized to the LigaSure™ group). There was no significant difference in the mean number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group (7.75 days versus 8.23 days; P = 0.613) and there was no significant difference in the mean total drain output between the monopolar diathermy group and the LigaSure™ group (523.50 ml versus 572.80 ml; P = 0.694). In addition, there was no significant difference in the mean operating time between the groups, for simple mastectomy alone (88.25 min for the monopolar diathermy group versus 107.20 min for the LigaSure™ group; P = 0.078) and simple mastectomy with sentinel lymph node biopsy (107.20 min for the monopolar diathermy group versus 114.40 min for the LigaSure™ group; P = 0.440). Conclusion In this double-blinded single-centre RCT, there was no difference in the total drain output or the number of days the drain remained in situ between the monopolar diathermy group and the LigaSure™ group. Registration number EudraCT 2018-003191-13 BEAUMONT HOSPITAL REC 18/66.

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Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial

Dehariya,

Agarwal,

Yadav

et al. 2023

World j. surg.

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Introduction We evaluated the impact of topical epinephrine with xylocaine on drainage after axillary lymph node dissection. Methods Fifty-two women were randomized into two groups, epinephrine with xylocaine drainage (ED) and conventional drainage group (CD). The amount of drainage, duration of drainage catheter, incidence of seroma formation and wound infection were noted. ResultsThe mean total drainage volume was less in ED group as compared to CD group (195 ml vs. 353 ml; p = .002). Drainage catheter was removed earlier in ED group as compared to CD group (5.07 ? / -0.99 days vs. 6.65 ? / -1.07 days; p = 0.0001). The incidence of seroma and wound infection was similar in two groups. Conclusion Topical epinephrine with xylocaine after axillary lymph node dissection results in significantly decreased drainage volume and duration of drainage.

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The role of tranexamic acid in reducing post-operative bleeding and seroma formation in breast surgery: A meta-analysis

Cited by 12 publications

References 52 publications

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

Reviewing the Impact of Topical and Intravenous Tranexamic Acid Use in Breast Plastic Surgery

Monopolar diathermy versus a vessel-sealing device for reducing postoperative drain output after simple mastectomy: randomized clinical trial

Impact of Topical Epinephrine with Xylocaine on Drainage After Axillary Lymph Node Dissection: A Randomized Controlled Trial

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