Postoperative use of drain in thyroid lobectomy – a randomized clinical trial conducted at Civil Hospital, Karachi, Pakistan

Abstract

BackgroundThyroidectomy is a common surgical procedure, after which drains are placed routinely. This study aims to assess the benefits of placing postoperative drains, its complications and affects on postoperative stay, in thyroid lobectomy.MethodologyRandomized Clinical Trial of 60 goitre patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July’11-December’11. Patients were randomly assigned into drain and non drain groups. Patient demographics, labs and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in non drain group it was calculated by ultrasound of neck on first and second post-op days. Data was entered and analyzed on SPSS v16 using Independent T tests.ResultThe mean total drain output for 2 days in non-drain group was significantly lower 10.67 (±9.072) ml while in drain group was 30.97 (±42.812) ml (p = 0.014). The mean postoperative stay of drain group (79.2 ±15.63 hours) was significantly higher, as compared to mean postoperative stay of non drain group (50.4 ±7.32 hours). Mean Visual Analogue Score (VAS) for pain day 1 (6.2 ±0.997) and day 2 (4.17 ±0.95) in drain group were significantly higher compared to day 1 (2.6 ±1.163) and day 2 (1.3 ±0.877 ) of non drain group. From drain group, 2 patients complained of stridor, dyspnea on Day 1 which subsided by Day 2 and 1 case of voice change, with no such complains in non drain group. No patients from both groups developed seroma, wound infection or hematoma.ConclusionIn uncomplicated surgeries especially for lobectomy, use of drain can be omitted.

Effect of Intraoperative Valsalva Maneuver Application on Bleeding Point Detection and Postoperative Drainage After Thyroidectomy Surgeries

“…3,5,8,9 Furthermore, it may trigger infection and prolong hospital stay if not changed frequently. 5,19 Only in certain cases where the patients use anticoagulants or undergo lymphatic dissection, the use of drains is recommended. 17 Optional tools are also suggested to replace drains for hematoma treatment, such as needle aspiration.…”

“…2,3 Despite the richness of the blood vessels in the thyroid area, 4 the rate of postoperational bleedings thus hematoma events are low (1-5% of the cases). 5 However, once not controlled, hematoma can result in airway compression and create a life-threatening situation for the patient. 6 Hence, preventive measures have been emphasized and employed to avoid postoperational bleedings after thyroidectomy.…”

“…However, recent literature indicates that the drain usage does not have a significant effect on the recovery period or on the duration of the hospital stay. 3,5,8,9 Furthermore, it may cause wound infection and contribute to the discomfort of the patients. 5,8,10,11 Thus a proper hemostasis and an early detection of potential bleeding sites are crucial steps for a successful operation and a steady recovery period.…”

“…3,5,8,9 Furthermore, it may cause wound infection and contribute to the discomfort of the patients. 5,8,10,11 Thus a proper hemostasis and an early detection of potential bleeding sites are crucial steps for a successful operation and a steady recovery period. 4 Several techniques have been used to detect and treat bleeding points immediately after the operation to prevent postoperational hematoma.…”

Routine Placement of Drain in Thyroid Surgery: Is There Any Scientific Basis?

“…In selected cases, placement of drain may be useful, like patients with recurrent goiter, substernal goiter and patients on anticoagulants. [7][8][9] CONCLUSION Thyroidectomy without drain causes less discomfort, short hospital stay and does not increase the risk of postoperative complications. Meticulous haemostasis and attention to finer details during surgery are more important for achieving this goal.…”