Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders

Abstract

Abstract:Objective: This prospective randomized clinical trial was conducted to evaluate the necessity of drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. Methods: A total of 116 patients who underwent total thyroidectomy or lobectomy for benign thyroidal disorders were randomly allocated to be drained or not. Operative and postoperative outcomes including operating time, postoperative pain assessed by visual analogue scale (VAS), total amount of intramuscular analgesic administration, hospital stay, complications, necessity for re-operation and satisfaction of patients were all assessed. Results: The mean operating time was similar between two groups (the drained and non-drained groups). The mean VAS score was found to be significantly low in the non-drained group patients in postoperative day (POD) 0 and POD 1. The mean amount of intramuscular analgesic requirement was significantly less in the non-drained group. One case of hematoma, two cases of seroma and three cases of transient hypoparathyroidism occurred in the non-drained group, whereas one case of hematoma, two cases of seroma, two cases of wound infections and two cases of transient hypoparathyroidism occurred in the drained group. No patient needed re-operation for any complication. The mean hospital stay was significantly shorter and the satisfaction of patients was superior in the non-drained group. Conclusion: These findings suggest that postoperative complications cannot be prevented by using drains after total thyroidectomy or lobectomy for benign thyroid disorders. Furthermore, the use of drains may increase postoperative pain and the analgesic requirement, and prolong the hospital stay. In the light of these findings, the routine use of drains might not be necessary after thyroid surgery for benign disorders.

Hemithyroidectomy with or without use of drain a randomized prospective clinical study

“…9,18 Few studies have observed infective complications with the use of drain, but we didn't find such associations with drain use in present study. 7,17,19 Author found decreased post-operative pain in group A (without drain) which has been already reported in previous few studies. 5,7 Because of reduced pain and less discomfort, author found decreased length of hospital stay in the non-drainage group without any morbidity.…”

“…7,17,19 Author found decreased post-operative pain in group A (without drain) which has been already reported in previous few studies. 5,7 Because of reduced pain and less discomfort, author found decreased length of hospital stay in the non-drainage group without any morbidity. Morrissey et al also demonstrated similar result in their study.…”

“…11 Most of the studies in literature concluded that suction drain is not necessary for routine thyroid surgery and the similar result author have got in present study for hemithyroidectomy. 2,5,7,9,11,19 Hence author believe that hemithyroidectomies are also safe without drains and no added advantages in keeping drains in thyroid surgeries.…”

“…[1][2][3][4] Hemorrhage can be life threatening which makes most of the surgeons to put the drain in thyroid surgery though the actual incidence is only 0.3 -1%. 1,5,[6][7][8] A number of studies have also failed to show any advantages of the drain in thyroid surgery. 2,5,6,[9][10][11] The routine use of drains seems to be more a result of surgical training rather than based on evidence.…”

Use of a Suction drain in Thyroid Surgery

“…This fear prompts surgeons to use routine drains after thyroid surgery. Post-operative bleeding is actually quite rare and occurs only in 0.3% to 1% of patients after thyroidectomy 1,2 Many studies have suggested that drains may be blocked with clotted blood and the surgeon may not be alerted even if major bleeding occurs. In our study we did not encounter any patient with post-operative bleeding and therefore are unable to comment on this.…”