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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 14  |  Issue : 1  |  Page : 3-7

Study on quantification of drain in intracapsular thyroidectomies


Department of ENT, JJM Medical College, Davangere, Karnataka, India

Date of Web Publication20-Feb-2017

Correspondence Address:
U P Santosh
“Saavan” No. 4123, 14th Cross, Anjaneya Layout, Davangere - 577 004, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-0354.200558

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  Abstract 

Introduction: Disease of the thyroid gland is common with prevalence of 4–7% in the general population. The incidence being higher in endemic areas. Thyroidectomy is an important procedure done for majority of thyroid swellings, after which drains are placed. Our study aims to assess the postoperative drain fluid amount in thyroidectomies done using intracapsular dissection technique. Materials and Methods: Retrospective study of 170 patients who underwent hemi/subtotal/total thyroidectomies using intracapsular dissection in Chigateri District Hospital and Bapuji Hospital, Teaching Hospitals, attached to JJM Medical College, Davangere during March 2009 to July 2015. All patients fulfilling inclusive criteria are included in the study. The drain was removed after 48 h of surgery. The amount of drain present was measured before removal of the drain. Results: Total number of 170 cases were analyzed. We found that the drain fluid amount was drastically less when compared with thyroidectomies done using other techniques. Conclusion: Drain fluid amount was minimal with thyroidectomies done using intracapsular dissection technique.

Keywords: Drain fluid amount, haematoma, intracapsular thyroidectomy, nonneoplastic


How to cite this article:
Santosh U P, Prashanth K B, Swetha K, Sumanth K R. Study on quantification of drain in intracapsular thyroidectomies. Thyroid Res Pract 2017;14:3-7

How to cite this URL:
Santosh U P, Prashanth K B, Swetha K, Sumanth K R. Study on quantification of drain in intracapsular thyroidectomies. Thyroid Res Pract [serial online] 2017 [cited 2017 Jun 25];14:3-7. Available from: http://www.thetrp.net/text.asp?2017/14/1/3/200558


  Introduction Top


Global prevalence of thyroid diseases is estimated at more than 2 billion with more than 40 million in India.[1] The number of thyroid diseases being diagnosed is increasing due to greater awareness.

Thyroid surgeries in the hands of experienced surgeons are currently one of the safest procedures performed. Better surgical techniques with better postoperative outcomes are being considered to give patients a very minimal morbidity and a quality life. The technique of intracapsular dissection emphasizes on minimal tissue handling of the surrounding structures and minimal dissection thereby reducing the postoperative complications and drain fluid amount [Figure 1] and [Figure 2].
Figure 1: Capsular dissection

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Figure 2: Drain 1 - before emptying the fluid collection

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After thyroid surgery, the main reason for surgeons to place drain is to detect early postoperative hemorrhage [2] and to avoid its risk of blocking the respiratory passage.[3]

It is believed that many surgeons use a drain following thyroid surgery to obliterate the dead space and evacuate collected blood and serum. This is further reinforced by the fact that postoperative drains usually yield fluid. Hemorrhage can be life-threatening, thus necessitating an immediate reexploration. This fear prompts surgeons to use a routine drain after thyroid surgery.

Objectives

To study the drain fluid amount in thyroidectomies for nonneoplastic thyroid lesions done using intracapsular dissection [Figure 1], [Figure 2], [Figure 3], [Figure 4].
Figure 3: Drain 2 - before emptying the fluid collection

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Figure 4: Drain 4 - readings on the drain

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  Materials and Methods Top


A retrospective study of patients diagnosed with benign thyroid swellings from Chigateri District Hospital and Bapuji Hospital, Teaching Hospitals attached to JJM Medical College, Davangere between March 2009 and July 2015 was done. Patients underwent hemi/subtotal/total thyroidectomies and drain was placed intraoperatively for all patients.

Patients of both the sex of all age group [Table 1], with clinically proved and cytologically diagnosed nonneoplastic swelling of the thyroid, who required surgical removal, were included in the study.
Table 1: Sociodemographic distribution

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Patients with previous thyroid surgeries and malignancies were excluded.

Thyroid swellings were evaluated by thyroid function test, fine needle aspiration cytology of the swelling and ultrasonography (USG) neck. Indirect and direct laryngoscopy were performed pre- and post-operatively as a routine protocol.

Intraoperatively drain can be drawn out through the incision made below the 1st surgical incision and kept loosely in the place with a platysma level dissolvable stitch. In the adjacent skin edge, 5-0 nylon can be placed and left long to tie when the drain is removed. Strap muscles are reapproximated with 3-0 absorbable suture [Figure 5] and [Figure 6].
Figure 5: Drain 3 - after emptying the fluid collection

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Figure 6: Drain 5 - fluid collection measured using a measuring jar

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Drain fluid amount was recorded and measured from the time of extubation until the removal of drain. The drain is removed after 48 h. The size of the drain used was 10 French. The method used for measuring the amount of fluid present in the drain was, by releasing the negative pressure of the drain [Figure 7], and the drain was emptied into a measuring jar. Later the drain amount is read as on the markings of the jar. The measurement readings were noted [Figure 8] and [Figure 9].
Figure 7: Postoperative specimen

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Figure 8: Histopathological slide - with capsule

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Figure 9: Histopathological slide - without capsule

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All these thyroidectomies were operated by the same surgeon to maintain uniformity.


  Results Top


In this study, we have analyzed the collection of drain following different thyroidectomies done using intracapsular dissection technique in 170 patients in Chigateri District Hospital and Bapuji Hospital between March 2009 and July 2015.


  Discussion Top


Thyroidectomies are one of the most common surgical procedures.

It is common practice for surgeons to routinely insert a drain after thyroid surgery.[3] This is mainly to the fear of postoperative hemorrhage [2] or accumulation of an excess of lymphatic fluid which needs to be drained as it can compromise the airway.[3] Postoperative bleeding after thyroid surgery is reported to be as rare as 0.3–1%,[4] while the probability of a postoperative cervical hematoma forming ranges between 0.1% and 4.7%.[5]

In addition, surgical techniques for benign thyroid disorders have improved greatly over the past several years, and postoperative morbidity and mortality rates have further decreased. Life-threatening complications, such as postoperative bleeding, hematoma, compression of air passages, can be avoided in most patients (Colak et al., 2004; Müller et al., 2001).

In real practice insertion of drain should be rationalized on the basis of the operative procedure performed and the extent of neck dissection.

In the clinical study conducted between January 2010 and January 2012, the subjects were 400 patients who underwent thyroid surgery. These patients were randomized through a computer-generated random number table into two groups according to whether or not drains were inserted at the time of surgery. Group 1 consisted of 200 patients without drains and group 2 consisted of 200 patients with drains. The amount of fluid collection in the thyroid bed was assessed by USG, at the postoperative 24th h in group 1. Student's t-test was applied to detect any difference in the means of fluid collection between the groups, but there was no statistically significant difference in the volume of fluid collection (P = 0.117). In group 2, the amount of fluid collected in the suction drain was noted over a 24-h period, with an average finding of 53.32 mL (range: 30–90 mL/day). The study failed to show any advantage in the routine use of the drain after thyroid surgery.[6]

In the study of randomized clinical trial of 60 goiter patients undergoing lobectomy was conducted at Civil Hospital Karachi, during July 11 to December 11. Patients were randomly assigned into drain and nondrain groups. Patient demographics, laboratories, and complications were noted. Ultrasound of neck was performed on both groups. For drain group, the amount of fluid present in the surgical bed and redivac drain was added to calculate fluid collection while in nondrain group it was calculated by ultrasound of neck on 1st and 2nd postoperative days. Data were entered and analyzed on SPSS v16 (Romsons Surgical Drains, Uttar Pradesh, India) using independent t-tests. The mean total drain output for 2 days in nondrain group was significantly lower 10.67 (±9.072) ml while in drain group was 30.97 (±42.812) ml (P = 0.014). It also showed that postoperative stay, costs, patient discomfort, and pain are greater in patients which have drain placement after thyroid surgery. In uncomplicated surgeries, especially in cases of lobectomy; use of drain can be omitted which will help decreasing chances of wound infection, with substantial shortening of patient stay while increasing patient comfort and satisfaction.[7]

In our study, we totally conducted 127 hemithyroidectomies, 10 subtotal thyroidectomies, and 33 total thyroidectomies [Table 2]. Majority were of multinodular goiter (117), solitary nodular goiter (34), colloidal goiter (18), and adenoma (1) [Table 3]. The average mean of the drain fluid amount immediately after extubation was 8.53 ml with a range of 5–20 ml and the average mean of the drain fluid amount after 24 h was 16.18 ml with a range of 10–50 ml. The t value of the paired t-test of these two means was −24.24 with a P < 0.000, which is statistically significant [Table 4].
Table 2: Operative procedure

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Table 3: Cytological diagnosis

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Table 4: Drain fluid amount

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The average mean of the drain fluid amount immediately after extubation in hemithyroidectomies was 8.15 ml, in subtotal thyroidectomies was 9.50 ml and in total thyroidectomies was 10.00 ml. The average mean of the drain fluid amount after 24 h in hemithyroidectomies was 15.24 ml, in subtotal thyroidectomies was 19.10 ml and in total thyroidectomies was 18.50 ml. The t value of the paired t-test of the drain fluid amount for each procedure was −23.7, −9.12 and −7.9 respectively, P < 0.000 for all the three procedures [Table 5].
Table 5: Drain fluid amount in each procedure

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  Conclusion Top


As the drain fluid amount is minimal with thyroidectomies using intracapsular dissection technique, nonplacement of drain can be considered in the view of co-morbidities, however, further studies are required.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Halstead WS. The operative story of goiter. Johns Hopkins Hosp Rep 1920;19:71-257.  Back to cited text no. 1
    
2.
Wihlborg O, Bergljung L, Mårtensson H. To drain or not to drain in thyroid surgery. A controlled clinical study. Arch Surg 1988;123:40-1.  Back to cited text no. 2
    
3.
Khanna J, Mohil RS, Chintamani D, Dinesh B, Mittal MK, Sahoo M, et al. Is the routine drainage after surgery for thyroid necessary? A prospective randomized clinical study. BMC Surg 2005;19:5-11.  Back to cited text no. 3
    
4.
Colak T, Akca T, Turkmenoglu O, Canbaz H, Ustunsoy B, Kanik A, et al. Drainage after total thyroidectomy or lobectomy for benign thyroidal disorders. J Zhejiang Univ Sci B 2008;9:319-23.  Back to cited text no. 4
    
5.
Calò PG, Pisano G, Piga G, Medas F, Tatti A, Donati M, et al. Postoperative hematomas after thyroid surgery. Incidence and risk factors in our experience. Ann Ital Chir 2010;81:343-7.  Back to cited text no. 5
    
6.
Deveci U, Altintoprak F, Sertan Kapakli M, Manukyan MN, Cubuk R, Yener N, et al. Is the use of a drain for thyroid surgery realistic? A prospective randomized interventional study. J Thyroid Res 2013;2013:285768.  Back to cited text no. 6
    
7.
Memon ZA, Ahmed G, Khan SR, Khalid M, Sultan N. Postoperative use of drain in thyroid lobectomy – A randomized clinical trial conducted at civil hospital, Karachi, Pakistan. Thyroid Res 2012;5:9.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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