[Drainage in thyroid surgery. Is it always a must?].
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.
Defechereux
T
T
Service de Chirurgie des Glandes Endocrines et Transplantation, Centre Hospitalier Universitaire de Liège, Belgique.
Hamoir
E
E
Nguyen Dang
D
D
Meurisse
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004322:Drainage / Q000706:statistics & numerical data; D005260:Female; D006406:Hematoma / Q000453:epidemiology / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012086:Reoperation; D012189:Retrospective Studies; D013959:Thyroid Diseases / Q000601:surgery*; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data