Uncomplicated Thyroid Surgery Research Articles

Thyroid Uncomplicated Surgery with Lack Placement of Drains. A Retrospective Analysis.

Thyroid drains after thyroid surgery are often used despite evidence. The aim of this retrospective study was to determine the post-operative complication rates following thyroid uncomplicate surgery without drain. The medical records of two hundred and thirty-nine patients who undergone thyroid surgery without and with drain were reviewed. The rate of post-operative either complications and pain were evaluated. The distribution of the operations performed were similar in two groups, in no-drain group (group A) there were total thyroidectomy 68.7% and lobectomy 31.3% while in drain group (group B) the total thyroidectomy were 70.8% and the lobectomy were 29.2%, this without statistical significant difference. Postoperative complications that occurred included seromas, hematoma and wound infections were without significantly differences. Postoperative pain was significantly lower in group A than in group B at two timepoint. The mean hospital stay was significantly shorter in the non-drained group. The no-drain uncomplicated thyroid surgery was safe and didn't increase a rates of post-operative complications. In addition, we achieved significant reduction of postoperative pain, hospital stay and overall costs.

Dysphagia following uncomplicated thyroidectomy: a systematic review.

Dysphagia after uncomplicated thyroidectomy is commonly reported and it includes a broad spectrum of swallowing complaints. Though various causes have been hypothesized, it remains not completely understood. A systematic review was performed to identify studies concerning dysphagia post uncomplicated thyroid surgery. A qualitative analysis of data extracted was conducted. We have included 16 studies of which 15 are prospective and one are retrospective. The number of subjects varied from 12 to 254, the mean age from 39 to 54years with an overall prevalence of females. The duration of the follow-up ranges from 1month to 4years. All the included trials documented postoperative dysphagia, 12 of which have detected it in the early postoperative period. Considering long-term follow-up period, 12 studies reported an overall improvement of swallow symptoms. The instrumental findings revealed non-specific alterations of swallowing. Dysphagia after uncomplicated thyroidectomy can arise early in the postoperative period resolving spontaneously in the first year. Diagnostic methods failed to identify the physio pathological mechanism of swallow alteration leaving this condition still unclear. Since these symptoms can reduce patient's quality of life, we suggest an appropriate education before thyroid surgery.

Surgical management of intrathoracic goitres

Intrathoracic goitres (ITG) often present with compressive symptoms and require specialised care by experienced surgical teams. Most ITG can be accessed by a transcervical approach (TCA) and only between 1 and 15% will require an extracervical approach (ECA). Many controversies exist regarding the clinical presentation, evaluation, selection of cases for ECA, surgical technique and outcomes. This paper reviews the recent literature onthe management, outcomes and evidence-based treatment strategies of ITG. We conducted a review of the literature on the evaluation, management and outcomes of surgery for ITGs. The incidence of cancer in the ITGs ranges between 4 and 20%. Multiplanar CT scanning offers the best preoperative evaluation and aids to determine the approach. Most ITG can be accessed by TCA and ECA are only needed in maximum 15% of cases. In experienced hands, the outcome of these surgeries is comparable to thyroid surgery for non-ITG. Surgery for ITG is challenging. The experienced surgeon however, with few exceptions can address ITG via TCA, with outcomes comparable to those of uncomplicated thyroid surgery.

Voice outcomes after thyroidectomy without superior and recurrent laryngeal nerve injury: VoiSS questionnaire and GRBAS tool assessment

Voice symptoms are frequently reported early after thyroidectomy, even in the absence of laryngeal nerves injury. We evaluated the short-term outcomes of these functional alterations. Thirty-nine patients were enrolled in a prospective observational trial, evaluating voice function before and 3months after uncomplicated thyroidectomy, using VoiSS as assessed using a validated patient rated questionnaire; and perceptual voice analysis using GRBAS scale (Grade, Roughness, Breathiness, Asthenia, Strain). Impact of dysphonia on patient's life using VoiSS questionnaire revealed differences between pre- and postoperative assessment. There was statistically significant worsening in the impairment subgroup of VoiSS (p=0.027). GRBAS evaluation was consistent between the three independent raters but showed differences between pre- and postoperative voice assessment. Age, TSH and a preoperative finding of laryngopharyngeal reflux significantly predicted quality of voice after thyroid surgery (all p<0.004), as identified by the GRBAS assessment tool, but not type of surgery, gender or smoking status; although prediction of total variance in changes of voice was modest (r 2=0.07). Voice changes may occur after thyroidectomy without evident laryngeal nerve injury. Patients should be made aware of possible mild changes in voice even after uncomplicated thyroid surgery and this might be considered to be part of the informed consent.

Early Neck Exercises to Reduce Post-Thyroidectomy Syndrome after Uncomplicated Thyroid Surgery: A Prospective Randomized Study

Copyright c 2014, the Korean Thyroid Association. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 갑상선절제술 후 경부불편감의 경감을 위한 조기 경부운동의 효과 분석: 무작위 전향적 연구

Is the Insertion of Drains After Uncomplicated Thyroid Surgery Always Necessary?

We conducted a prospective, randomized study to evaluate the necessity of drainage after uncomplicated thyroid surgery. The subjects were 135 patients who underwent thyroid surgery between September 2002 and February 2004. The patients were randomized into two groups according to whether drains were inserted at the time of surgery. Group 1 consisted of 68 patients with drains and group 2 consisted of 67 patients without drains. The indications for surgery, procedures performed, local complications (such as infection, seroma, and bleeding or hematoma), necessity for reoperation, and hospital stay were recorded. There were 110 (81.5%) women and 25 (18.5%) men, with a median age of 46.9 +/- 12.5 years. The mean hospital stay was 2.6 +/- 1.0 days in group 1 and 1.3 +/- 0.7 days in group 2 (P = 0.001). Local complications developed in five (7.3%) patients from group 1, as wound infections in two (2.9%), seroma in one (1.5%), and hemorrhage in two (2.9%); and in two (3%) patients from group 2, as seroma in one (1.5%) and hematoma in one (1.5%). Both of the group 1 patients with postoperative hemorrhage required reoperation within 8 h after initial surgery. The hematoma in the group 2 patient was treated successfully with needle aspiration. These findings suggest that the routine use of drains may be abandoned in uncomplicated thyroid surgery, since serious postoperative bleeding rarely occurs and hematomas can be treated by needle aspiration if drains have not been placed. Furthermore, the use of drains prolongs hospital stay and increases the risk of infection.

甲状腺手術後のドレナージは必要か？

The need for drainage to prevent complications after thyroid surgery has been questioned by many authors since the late 1980s. However, little is known about the quantity of discharge after thyroid surgery.We measured the amount of discharge drained continuously after hemithyroidectomy with or without contra-lateral tumor enucleation in 90 consecutive patients (10 males and 80 females, mean age 56 years, ranging in age from 24-79 years) with benign (78 cases) and malignant (12 cases) thyroid tumors. The amount of drainage was not huge and ranged from 8 to 132ml with a mean of 51ml during the 4 days after surgery. The average amount was significantly larger in the patient group drained with a stronger suction system (J-VAC), when compared to that in the group with a weaker suction system (MANOVAC).Where immediate action based on close observation of patients is available under life-threatening conditions, such as massive bleeding or airway obstruction, prophylactic routine drainage is not necessary after uncomplicated thyroid surgery.

Thyroid surgery without drain

Use of surgical drains after thyroid surgery is standard surgical practice to prevent lifethreatening complications, arising from post-operative haematoma. There is increasing evidence to suggest that this is an outdated practice. This study determines whether thyroid surgery can be safely performed without the routine use of drains. This cross sectional study was done for two years and one hundred thyroidectomies were performed. No drains were inserted in any patient. Complications of thyroid surgery in this series were seroma formation (5%) cases and minor haematoma was only 1%. Re-exploration for bleeding was not encountered in any cases in this series. There is no evidence to suggest the routine use of surgical drains following uncomplicated thyroid surgery. Key words: Thyroid Surgery; Drain DOI: http://dx.doi.org/10.3329/bjo.v17i2.8852 BJO 2011; 17(2): 121-124