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[Drainage in thyroid surgery. Is it always a must?]
T Defechereux1, E Hamoir, D Nguyen Dang
1Service de Chirurgie des Glandes Endocrines et Transplantation, Centre Hospitalier Universitaire de Liège, Belgique.
Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. A retrospective review of a personal series of 1789 thyroidectomies over a 3 1/2-year period was conducted. Except for thyroid cancer surgery with lymphadenectomy and large mediastinal goiters requiring sternotomy, no case selection for non-drainage was employed. Patients were stratified only on a chronological basis, according to whether key were drained (n = 575, 1993-1994) or not drained (n = 1214, 1994-1996). Both series included toxic goiters, large plunging compressive goiters, bilateral and redo procedures. Severe life-threatening hematoma requiring reexploration occurred in 5 drained patients (0.9%) and in 5 undrained patients (0.4%). Minor postoperative wound hematoma were conservatively treated in 17 drained patients (2.9%) and 6 undrained patients (1.3%). In our experience, drainage after thyroid surgery may not mandatory provided that the field is completely dry before closure. We therefore, progressively modified our operative strategy in order to improve a meticulous haemostatic technique, considered to be more important than the use of drains. Meticulous surgical technique and obliteration of dead space led us to observe a dramatic decrease of the incidence of hemorrhagic complications, eliminating the need for systematic drainage after thyroid surgery.
Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. A retrospective review of a personal series of 1789 thyroidectomies over a 3 1/2-year period was conducted. Except for thyroid cancer surgery with lymphadenectomy and large mediastinal goiters requiring sternotomy, no case selection for non-drainage was employed. Patients were stratified only on a chronological basis, according to whether key were drained (n = 575, 1993-1994) or not drained (n = 1214, 1994-1996). Both series included toxic goiters, large plunging compressive goiters, bilateral and redo procedures. Severe life-threatening hematoma requiring reexploration occurred in 5 drained patients (0.9%) and in 5 undrained patients (0.4%). Minor postoperative wound hematoma were conservatively treated in 17 drained patients (2.9%) and 6 undrained patients (1.3%). In our experience, drainage after thyroid surgery may not mandatory provided that the field is completely dry before closure. We therefore, progressively modified our operative strategy in order to improve a meticulous haemostatic technique, considered to be more important than the use of drains. Meticulous surgical technique and obliteration of dead space led us to observe a dramatic decrease of the incidence of hemorrhagic complications, eliminating the need for systematic drainage after thyroid surgery.