Assessment of Routine Drainage in Elective Thyroid Surgery. A Prospective Randomized Study

Abstract

Background: At the end of thyroidectomy surgery, there was an area of some debate about insertion of closed suction drain before closure. The decision of routine use of drain depends on the surgeon’s training, experience, and personal preference. Many surgeons prefer to place drain to minimize dead space collection and to prevent or reduce the post-operative hematoma that may be life-threatening so, the insertion of drains was generally accepted, although there are many studies that show no difference in the rate of complication with or without drain insertion. Moreover drain insertion may be accompanied by many hazards such as more hospital stay and post-operative pain. So, the concept of routine use of drain should be revised in the light of recent reports that test the real need for its use. Aim of the study: this study aimed to assess if there was actual benefit from the use of drain in thyroid surgery and to evaluate the necessity of its use in thyroid surgery and to detect hazards of its use. Patients and methods: between June 2015 and July 2018, a prospective randomized study included 87 patients from those had elective thyroid surgery in Al-Hussien University Hospital for different indications. Patients had been categorized into 2 groups; group A (93 patients) for thyroidectomy without insertion of drain and group B (93 patients) for thyroidectomy with insertion of suction drain. In the study, results including: post-operative pain, hospital stay and complications (including wound infection, seromas, post-operative bleeding, hematoma, recurrent laryngeal nerve (RLN) palsy or hypoparathyroidism) were documented. Follow up after patient discharge was done until healing of wounds to detect post-operative complications. Results: the overall postoperative complications rate in the study was low (13 patients) in the two groups. In the non-drained group, there were one case of hematoma ( 2.5 %), 2 cases of seroma ( 5.1 %), one case of RNL palsy ( 2.5 %), one case of transient hypoparathyroidism (2.5 %) and no cases of wound infection, whereas in the other group, there were 2 cases of hematoma ( 5.1 %), 3 cases of seroma ( 7.6 %), 2 case of RNL palsy ( 5.1 %), 2 case of transient hypoparathyroidism ( 5.1 %) and no cases of wound infection. There was no statistical significance between both groups as regard incidence of complications. In the non- drained group, 37 patients (94.8 %) were discharged at the next day after surgery while in the drained group 2 patients (5.1%) only were discharged in the next day and the remaining patients were discharged after removal of drain after 48 hours. The mean hospital stay for the non- drained group was 1.2±1 days and the mean hospital stay for the drained group was 2.1±1 days. Conclusion: in the study, use of drain in thyroid surgery did not have significant effect on the rate of incidence or prevention of postoperative complications. In serious postoperative bleeding, the drain which usually has small pores often become blocked be blood clots and become useless. On contrary, insertion of drain prolongs patient hospital stay and increases postoperative pain. So, routine use of drain in elective thyroid surgery should be prohibited.