Varsha, Madhavnarayan Totadri (2020) A Comparative study of Drainage of Breast Abscesses by Conventional Incision and Drainage Vs Ultrasound Guided Needle Aspiration / Reaspiration in a Tertiary Health Care Centre. Masters thesis, Stanley Medical College, Chennai.
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Abstract
INTRODUCTION: Breast abscess continues to be a major cause of morbidity in developing countries. The treatment of breast abscess continues to be a challenge. Traditionally, treatment of breast abscess involved incision and drainage which is done under general anaesthesia following which the patient requires frequent dressing, will have unsightly scar formation and lactating mothers tend to avoid breast feeding after treatment. With this continuously tried method of incision and drainage, the recurrence rate is still high. Treatment of breast abscess has modified from invasive methods to less invasive procedures. The conventional method of incision and drainage (I and D), breaking loculi and insertion of a drain under general anesthesia has shifted to a minimally invasive approach of aspiration. The following study aims at establishing the necessity and the advantages of adopting a less invasive method of management of breast abscess which is also technically feasible. AIMS AND OBJECTIVES: To compare management of breast abscess by incision and drainage v/s USG guided needle aspiration/re-aspiration (under antibiotic coverage) with respect to 1. Residual abscess 2. Recurrence 3. Clinical outcome of patient basis functional and cosmetic criteria METHODS: 50 patients admitted with a diagnosis of breast abscess were included in the study for a period of 9 months. Diagnosis of breast abscess was confirmed by clinical examination and ultrasound findings. Written and informed consent was obtained and patients were alloted randomly into 2 groups 1. Group 1- Underwent incision and drainage 2. Group 2- Underwent ultrasound guided needle aspiration/re-aspiration of abscess cavity All patients were given appropriate antibiotic coverage primarily with injection Cloxacillin 500mg iv BD (ATD) and injection Metrogyl 500mg iv TDS. Each patient underwent appropriate management as per the group allotted. Ultrasound scan of the operated/drained breast was done on day 3 and 7 post operatively/post drainage to rule out residual abscess. Each patient was analysed on the basis of residual abscess, recovery time period, recurrence of abscess and resumption of functionality for lactating mothers. Both groups were compared based on multiple factors to assess the better method of management of breast abscess and the comparative charts and parameters have been documented and analysed. Each patient in the study was followed up 2 weeks after discharge to assess clinical improvement. RESULTS: A comparative study of drainage of breast abscess by conventional incision and drainage versus ultrasound guided needle aspiration/re-aspiration in a tertiary health care centre was done to compare management in terms of residual abscess, recurrence and clinical outcome of patient basis functional and cosmetic criteria. A total of fifty patients were studied prospectively for nine months. The following is a summary of the results: 1. 96% of patients in Group A (who underwent incision and drainage) had residual abscess, edema, collection whereas 44% of patients in group B (who underwent USG guided aspiration) completely normalized and recovered with no residual abscess/recurrence. 2. 25% of patients who underwent incision and drainage had residual abscess on POD 7 whereas only 12% had residual abscess on POD 7 3. 28% of patients who underwent incision and drainage had a recurrence of breast abscess after 2 weeks, whereas no patient who underwent USG guided aspiration had any recurrence after 2 weeks. 4. 91.67% of lactating mothers in the USG guided aspiration group, resumed breastfeeding after treatment whereas only 20% of lactating mothers who underwent incision and drainage, resumed breastfeeding. 5. Mean healing time in I and D group was 13.9 days whereas in USG guided aspiration group mean healing time was 5 days 6. 100% of patients who underwent incision and drainage had a scar whereas no patient who underwent USG guided aspiration of breast abscess had any scar CONCLUSION: The method of management of breast abscess must be decided based on different factors such as ease of technique, feasibility, acceptance, time for complete healing, cosmetic and functional outcome. As explicitly noted from the above results, USG guided aspiration/re-aspiration of breast abscess is the better, more feasible and more acceptable method of management of breast abscess. Based on the overall advantages of USG guided aspiration over incision and drainage, it is safe to conclude that USG guided aspiration is a safer and more effective method of treatment of breast abscess especially when initiated early and immediately after diagnosis.
| Item Type: | Thesis (Masters) |
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| Additional Information: | 221711069 |
| Uncontrolled Keywords: | Breast abscess, USG Guided aspiration, residual abscess, recurrence, lactation, scar formation. |
| Subjects: | MEDICAL > General Surgery |
| Depositing User: | Subramani R |
| Date Deposited: | 09 Feb 2021 02:17 |
| Last Modified: | 09 Feb 2021 02:17 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13956 |
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