Abstract
We designed and conducted the present study to evaluate the optimal wound closure technique after thyroid and parathyroid surgery in terms of perioperative safety, efficacy, and cosmetic outcomes. A systematic literature review and network meta-analysis (NMA) was performed according to the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. Literature screening was completed at 10/12/2021. A random effects multivariate network meta-analysis under a frequentist framework was implemented. Statistical significance was considered at the level of p < 0.05. Overall, 18 studies and 1314 patients were included. Conventional sutures (CS) received the best ranking (SUCRA: 90.1%) in wound-related morbidity. Metal clips (MC) was the best option for reducing the overall operation (SUCRA: 99%) and wound closure (SUCRA: 72.3%) duration. Moreover, adhesive strips (AS) had the higher probability of minimizing postoperative pain during the 2nd and 3rd postoperative days. Subcuticular suture (SS) was the most probable method for achieving optimal, long-term, patient-assessed, and surgeon-assessed cosmesis. However, MC had the highest mid and long term, independent-assessed, scar ranking (SUCRA 80.5% and 62.9%). Based on the inconclusive results and the several study limitations, further large-scale RCTs are required.
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