Safety of thyroidectomy and cervical neck dissection without drains

Abstract

Background: Many studies have reported that drainage after thyroidectomy does not decrease the rate of local postoperative complications. We sought to review the safety of thyroidectomy combined with cervical neck dissection (CND) without drainage. Methods:The medical records of consecutive patients who underwent thyroidectomy without drainage were retrospectively reviewed. Two groups were defined depending on whether CND was or was not performed. The main outcome was identification of patients with cervical bleeding, hematoma or seroma. Results:We included 1127 patients (139 who had CND and 988 who did not). Of these, 207 patients (18%) had transient postoperative hypocalcemia, 9 (0.8%) had permanent postoperative hypoparathyroidism, 56 (5%) had transient postoperative hoarseness and 7 (0.6%) had permanent vocal cord paralysis. A total of 44 patients (4%) experienced postoperative hematoma and/or seroma: 8 patients (6%) who had CND and 36 (4%) who did not. There was no major bleeding in the 2 groups; all patients had minor bleeding or seroma not requiring surgical intervention. The postoperative stay in hospital for both groups was 1 day in 92% of patients. Wound infection occurred in 0.8% of all patients: 1 (0.7%) who had CND and 8 (0.8%) who did not. There was no significant difference between the groups in overall perioperative complications or in time of hospital discharge. Conclusion:Thyroidectomy without drains is safe and effective, even in combination with CND.

Effect of teaching patients neck stretching exercises on neck pain and disability following thyroidectomy

“…This finding was nearly the same as that reported by Abboud et al [19] in their study entitled safety of thyroidectomy and cervical neck dissection without drains who found that the majority of the studied patients performed total thyroidectomy.…”

“…Grading of neck pain and disability index questionnaire was as follows: No disability (0-4), Mild disability (5-14), Moderate disability (15)(16)(17)(18)(19)(20)(21)(22)(23)(24), Severe disability (25-34), and Complete disability equals 35 or over.…”

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

“…4 Additionally, a precise control over potential bleeding points was unceasingly brought into attention as a crucial step to the recovery process by preventing hematoma and excessive drainage. 4,6,11,12 Therefore, in this study we aimed to evaluate the effect of Valsalva maneuver application on the detection of bleeding sites and more importantly on postoperative parameters, such as the drainage and complications particularly after thyroidectomy operations.…”

“…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.…”

Systematic review of international guidelines for perioperative antibiotic prophylaxis in Head & Neck Surgery. A YO‐IFOS Head & Neck Study Group Position Paper

“…Clean H&N surgery incudes thyroidectomy, parathyroidectomy, salivary gland excisions, congenital neck masses (branchial cleft, thyroglossal duct, and dermoid cysts), nerve sheath tumors, and neck dissections. Considering the low infection rates without the use of antibiotics reported in different case series, prophylaxis may not be necessary for thyroidectomy [120][121][122][123][124][125][126][127] and parotidectomy. [128][129][130] An RCT of 500 patients showed no difference in SSI rates with or without a single dose of intraoperative sulbactam/ampicillin in clean H&N surgery (0.01% vs 0.02%).…”