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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 1999 December;12(6):419-22
Use of drainage in thyroid surgery
Giovannini C., De Milito R., Pronio A., Santella S., Montesani C.
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Background. The insertion of drainage in thyroid surgery is a procedure that is often used by many surgeons as an indicator of the most commonplace, albeit rare, postoperative complication for this type of operation: bleeding. It is also used to drain any serum or blood that may collect in the residual cavity after thyroidectomy.
Methods. The authors commenced a random prospective study in order to evaluate the advantages and disadvantages of using drainage, with regard to the more immediate complications and the long-term cosmetic benefits. A total of 144 patients were enrolled in the study and according to a random selection drainage was used in 80 cases. No drainage was inserted in the remaining 64 patients. The following parameters were evaluated in the two groups of patients: 1) wound status: presence of edema on flaps, ecchymosis or the appearance of swelling caused by hematic collections. The wounds were re-examined after one week, 20 days and, if necessary, after 40 days. 2) Leukocytosis above 10,000 WBC between the first and second day after surgery. 3) Fever over 37.5 ºC between the first and second day after surgery.
Results. We observed 13% of wound complications in Group A compared to 27% in Group B (p > .1). Leukocytosis over 10,000 WBC was present in 55% of patients in Group A, compared to 28% in Group B (p = 0.01). In 20% of patients in Group A, body temperature between the first and second postoperative day was > 37.5 ºC compared to 18% in Group B (p > 0.1). The scar had almost disappeared in 95% of patients in both groups 40 days after surgery. However, a significant number of patients presented leukocytosis in the group with drainage, even without fever.
Conclusions. In conclusion, the authors affirm that drainage in thyroid surgery should be limited to selected cases: in Basedow's disease and Basedoid goitre, where there is abundant capsular and parenchymal blood supply, leading to increased intraoperative bleeding and more difficult hemostasis; also in cases of immersed goitre, or if there are coagulation disorders. The routine use of drainage in other cases does not appear to improve the immediate results or long-term cosmetic results, whereas the decision not to insert drainage makes the postoperative period simpler for the patient.