The achilles heel of minimally invasive inguinal lymph node dissection: Seroma formation

Objective: To describe the incidence of post-operative seroma and interventions attempted to reduce this complication in patients undergoing minimally invasive inguinal lymph node dissection (MILND). Background: MILND has resulted in fewer wound complications, hospital readmissions, and shorter length of stay; unfortunately, seroma formation remains a major source of morbidity. Methods: A retrospective study of MILNDs performed from 2010 to 2017 was conducted. Different interventions were trialed attempting to combat this problem. We report the analysis with respect to seroma formation. Results: Forty-one patients underwent 44 MILND. Twenty-two (50%) patients developed symptomatic seroma requiring aspiration and/or drain placement. Risk factors associated with seroma on univariate analysis were increased number of metastatic nodes (p = 0.028), increasing BMI (p = 0.046), increasing age (p = 0.056), and larger suction drain bulbs (p = 0.013). There was an association with postoperative seroma formation and post-operative lymphedema (p = 0.001). Multiple interventions trialed to reduce seroma formation were unsuccessful in reducing the seroma rate. Conclusion: Seromas formation continues to be a common morbidity following MILND. Further research is needed to determine how seroma incidence can be reduced in patients undergoing MILND. (C) 2019 Elsevier Inc. All rights reserved.