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Ha EJ, Lee J. The effect of fibrin glue on the quantity of drainage after thyroidectomy: a randomized controlled pilot trial. Ann Surg Treat Res 2022; 102:177-184. [PMID: 35475227 PMCID: PMC9010963 DOI: 10.4174/astr.2022.102.4.177] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 02/27/2022] [Accepted: 03/08/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose A seroma is a collection of exudates after surgical trauma in wound healing. Fibrin glue is used to prevent seroma by reducing the generation of exudate. However, the impact of fibrin glue on the prevention of seroma remains debatable. Therefore, we conducted a randomized controlled pilot trial to investigate the effect of the amount of fibrin glue used on the generation of exudate after thyroidectomy and the sample size of future definitive trials. Methods Between February and December 2020, 41 patients were enrolled; 21 patients in the low fibrin group and 20 in the high fibrin group. Stratified randomization was performed based on sex, body mass index, and thyroiditis. All patients underwent total thyroidectomy and bilateral central compartment dissection. In the low and high fibrin groups, 2 mL and 6 mL of fibrin glue were applied to patients, respectively. Results Both the total drain volume and flow rate during the first 12 hours were lower in the high fibrin group than in the low fibrin group (65.0 mL vs. 47.6 mL, P = 0.008 and 2.7 mL/hr vs. 1.8 mL/hr, P = 0.002, respectively). The calculated sample size for future randomized controlled trial was 32 patients (α = 0.05, power = 0.8), and the power of this trial was 0.91 with µ1 = 2.7, µ2 = 1.8, σ = 0.9, and α = 0.05 (µ = mean, σ = standard deviation). Conclusion Six milliliters of fibrin glue could reduce total drain volume and flow rate of exudate after thyroidectomy. Therefore, applying an appropriate amount of fibrin glue after thyroidectomy may reduce postoperative seroma.
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Affiliation(s)
- Eun Ju Ha
- Department of Radiology, Ajou University School of Medicine, Suwon, Korea
| | - Jeonghun Lee
- Department of Surgery, Ajou University School of Medicine, Suwon, Korea
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Musholt TJ, Bockisch A, Clerici T, Dotzenrath C, Dralle H, Goretzki PE, Hermann M, Holzer K, Karges W, Krude H, Kussmann J, Lorenz K, Luster M, Niederle B, Nies C, Riss P, Schabram J, Schabram P, Schmid KW, Simon D, Spitzweg C, Steinmüller T, Trupka A, Vorländer C, Weber T, Bartsch DK. [Update of the S2k guidelines : Surgical treatment of benign thyroid diseases]. Chirurg 2019; 89:699-709. [PMID: 29876616 DOI: 10.1007/s00104-018-0653-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Thyroid resections represent one of the most common operations with 76,140 interventions in the year 2016 in Germany (source Destatis). These are predominantly benign thyroid gland diseases. Recommendations for the operative treatment of benign thyroid diseases were last published by the CAEK in 2010 as S2k guidelines (Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e.V. [AWMF] 003/002) against the background of increasingly more radical resection procedures. Hemithyroidectomy and thyroidectomy are routinely performed for benign thyroid disease in practice. The operation-specific risks show a clear increase with the extent of the resection. Therefore, weighing-up of the risk-indications ratio between unilateral lobectomy or thyroidectomy necessitates an independent evaluation of the indications for both sides. This principle in particular has been used to update the guidelines. In addition, the previously published recommendations of the CAEK for correct execution and consequences of intraoperative neuromonitoring were included into the guidelines, which in particular serve the aim to avoid bilateral recurrent laryngeal nerve paralysis. Moreover, the recommendations for the treatment of postoperative complications, such as hypoparathyroidism and postoperative infections were revised. The updated guidelines therefore represent the current state of the science as well as the resulting surgical practice.
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Affiliation(s)
- T J Musholt
- Sektion Endokrine Chirurgie der Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin der Johannes Gutenberg Universität Mainz, Langenbeckstr. 1, 55101, Mainz, Deutschland.
| | - A Bockisch
- Klinik für Nuklearmedizin, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - T Clerici
- Klinik für Chirurgie, Kantonsspital St. Gallen, 9007, St. Gallen, Schweiz
| | - C Dotzenrath
- Klinik für endokrine Chirurgie, Helios Universitätsklinikum Wuppertal, Heusnerstr. 40, 42283, Wuppertal, Deutschland
| | - H Dralle
- Sektion Endokrine Chirurgie, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - P E Goretzki
- Chirurgische Klinik, Campus Charite Mitte/Campus Virchow Klinikum, Endokrine Chirurgie, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - M Hermann
- 2. Chirurgische Abteilung, Krankenanstalt Rudolfstiftung, Märzstr. 80, 1150, Wien, Österreich
| | - K Holzer
- Sektion Endokrine Chirurgie der Viszeral‑, Thorax- u. Gefäßchirurgie, Universitätsklinikum Marburg, Baldingerstr., 35043, Marburg, Deutschland
| | - W Karges
- Sektion Endokrinologie und Diabetologie - Medizinische Klinik III, Universitätsklinikum Aachen, RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland
| | - H Krude
- Klinik für Pädiatrie mit Schwerpunkt Endokrinologie und Diabetologie, Charité Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland
| | - J Kussmann
- Klinik für Endokrine Chirurgie, Schön Klinik Hamburg-Eilbeck, Dehnhaide 120, 22081, Hamburg, Deutschland
| | - K Lorenz
- Klinik u. Poliklinik f. Allgem.-, Viszeral- u. Gefäßchirurgie, Universitätsklinikum Halle, Ernst-Grube-Str. 40, 06120, Halle, Deutschland
| | - M Luster
- Nuklearmedizin, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
| | - B Niederle
- Sektion Endokrine Chirurgie, Franziskus Spital, Nikolsdorfergasse 32, 1050, Wien, Österreich
| | - C Nies
- Klinik für Allg.- u. Viszeralchirurgie, Marienhospital Osnabrück, Bischofsstr. 1, 49074, Osnabrück, Deutschland
| | - P Riss
- Chirurgische Universitätsklinik, Währinger Gürtel 18-20, 1090, Wien, Österreich
| | - J Schabram
- Klinik für Endokrine Chirurgie, Asklepios Klinik Lich, Goethestr. 4, 35423, Lich, Deutschland
| | - P Schabram
- Anwaltskanzlei Ratajczak & Partner, Heinrich-von-Stephan-Str. 25, 79100, Freiburg im Breisgau, Deutschland
| | - K W Schmid
- Pathologie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland
| | - D Simon
- Klinik f. Allg.- u. Viszeralchirurgie, Ev. Bethesda Krankenhaus Duisburg GmbH, Heerstr. 219, 47053, Duisburg, Deutschland
| | - Ch Spitzweg
- Medizinische Klinik und Poliklinik II, LMU Klinikum der Universität München - Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland
| | - Th Steinmüller
- Chirurgische Abteilung, Zentrum f. Allg.- u. Viszeralchirurgie, DRK-Kliniken Westend, Spandauer Damm 130, 14050, Berlin, Deutschland
| | - A Trupka
- Chirurgische Klinik, Klinikum Starnberg GmbH, Oßwaldstr. 1, 82319, Starnberg, Deutschland
| | - C Vorländer
- Endokrine Chirurgie, Bürgerhospital Frankfurt am Main, Nibelungenallee 37-41, 60318, Frankfurt am Main, Deutschland
| | - T Weber
- Klinik für Endokrine Chirurgie, Katholisches Klinikum Mainz, An der Goldgrube 11, 55131, Mainz, Deutschland
| | - D K Bartsch
- Klinik für Visceral‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Gießen und Marburg, GmbH, Standort Marburg, Baldingerstrass, 35041, Marburg, Deutschland
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Eweida AM, Ebeed HM, Sakr MF, Hamza Y, Gabr E, Koraitim T, Al-Wagih HF, Abo-Elwafa W, Abdel-Aziz TE, Nabawi AS. Independent predisposing factors for subcutaneous and deep wound collection after total thyroidectomy, a prospective cohort study. Ann Med Surg (Lond) 2018; 36:10-16. [PMID: 30364680 PMCID: PMC6197755 DOI: 10.1016/j.amsu.2018.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Accepted: 10/11/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The literature contains diverse and sometimes contradicting results about wound seroma following thyroidectomy. This is probably due to the subjective clinical estimation of seroma, or due to failure to differentiate between the occurrence of subcutaneous (SC) and deep wound collections. This work aimed at objectively investigating the factors affecting subcutaneous and deep wound seroma after thyroidectomy. METHODS The relation between various operative and clinico-pathological factors and the collection formation was prospectively analyzed in a cohort of 100 patients after conventional thyroidectomy. Wound seroma was assessed clinically and via high-resolution ultrasonography at 24 h, 48 h and two weeks postoperatively. Sonographically detected collections were expressed as SC and/or deep wound collections according to the relation to strap muscles. RESULTS Operative duration was the only independent factor significantly affecting the incidence of clinical seroma. Older patients (>40ys) showed significantly larger volumes of early SC collections. Early postoperative pain was significantly related to drain insertion, to the occurrence of clinical seroma and to the volume of SC collections.Sonographically, suction drains and shorter operative durations resulted in significantly less amount of deep collections. Suction drains did not result in less amount of SC collections or in a lower incidence of clinical seroma. CONCLUSIONS Operative duration is the only independent factor significantly related to clinically-detected postoperative seroma with its subsequent postoperative pain. Especially in elderly patients, a flapless technique would be recommended as these patients developed larger volumes of SC collections with subsequent higher pain scores, even if seroma was not clinically detected.
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Affiliation(s)
- Ahmad Mahmoud Eweida
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
- Department of Plastic and Reconstructive Surgery, University of Heidelberg, Germany
- Corresponding author. Department of Plastic Surgery, BG Trauma Centre Ludwigshafen, University of Heidelberg, Ludwig-Guttmann-Str. 13, D-67071, Ludwigshafen, Germany.
| | - Hafsa Mohamed Ebeed
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Mahmoud Fathy Sakr
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Yasser Hamza
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Essam Gabr
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Tarek Koraitim
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Hatem Fawzy Al-Wagih
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
- Surgery Unit, Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Waleed Abo-Elwafa
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
| | - Tarek Ezzat Abdel-Aziz
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
- Department of Endocrine Surgery, University College London, London, UK
| | - Ayman Sameh Nabawi
- Head, Neck and Endocrine Surgery Unit (HNESU), Department of Surgery, Faculty of Medicine, University of Alexandria, Egypt
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Salem FA, Almquist M, Nordenström E, Dahlberg J, Hessman O, Lundgren CI, Bergenfelz A. A Nested Case-Control Study on the Risk of Surgical Site Infection After Thyroid Surgery. World J Surg 2018; 42:2454-2461. [PMID: 29470699 PMCID: PMC6060833 DOI: 10.1007/s00268-018-4492-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Introduction It is unclear if antibiotic prophylaxis reduces the risk of surgical site infection (SSI) in thyroid surgery. This study assessed risk factors for SSI and antibiotic prophylaxis in subgroups of patients. Method and design A nested case–control study on patients registered in the Swedish National Register for Endocrine Surgery was performed. Patients with SSI were matched 1:1 by age and gender to controls. Additional information on patients with SSI and controls was queried from attending surgeons using a questionnaire. Risk factors for SSI were evaluated by logistic regression analysis and presented as odds ratio (OR) with 95% confidence interval (CI). Results There were 9494 operations; 109 (1.2%) patients had SSI. Patients with SSI were older (median 53 vs. 49 years) than patients without SSI p = 0.01 and more often had a cancer diagnosis 23 (21.1%) versus 1137 (12.1%) p = 0.01. In the analysis of patients with SSI versus controls, patients with SSI more often had post-operative drainage 68 (62.4%) versus 46 (42.2%) p = 0.01 and lymph node surgery 40 (36.7%) versus 14 (13.0%) p < 0.01, and both were independent risk factors for SSI, drain OR 1.82 (CI 1.04–3.18) and lymph node dissection, OR 3.22 (95% CI 1.32–7.82). A higher number of 26(62%) patients with independent risk factors for SSI and diagnosed with SSI did not receive antibiotic prophylaxis. Data were missing for 8 (31%) patients. Conclusion Lymph node dissection and drain are independent risk factors for SSI after thyroidectomy. Antibiotic prophylaxis might be considered in patients with these risk factors.
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Affiliation(s)
- F A Salem
- Department of Clinical Sciences, Lund University, Lund, Sweden. .,Skåne University Hospital, 221 85, Lund, Sweden.
| | - M Almquist
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - E Nordenström
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - J Dahlberg
- Department of Endocrine Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - O Hessman
- Department of Endocrine Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - C I Lundgren
- Department of Endocrine Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - A Bergenfelz
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Bures C, Klatte T, Friedrich G, Kober F, Hermann M. Guidelines for complications after thyroid surgery: pitfalls in diagnosis and advices for continuous quality improvement. Eur Surg 2014. [DOI: 10.1007/s10353-013-0247-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Bures C, Klatte T, Gilhofer M, Behnke M, Breier AC, Neuhold N, Hermann M. A prospective study on surgical-site infections in thyroid operation. Surgery 2013; 155:675-81. [PMID: 24502803 DOI: 10.1016/j.surg.2013.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 12/06/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND To evaluate the incidence and the microbe spectrum of surgical-site infections (SSIs) in patients undergoing elective thyroid operation and to develop a risk factor-based predictive model. METHODS This prospective study included 6,778 consecutive patients who underwent thyroid operation at a single institution between 2007 and 2012. SSI was defined according to the Centers for Disease Control and Prevention. Regression models were fitted to evaluate risk factors for SSI. A predictive nomogram was constructed from relevant variables in the multivariable analysis. Discrimination and calibration of the nomogram were assessed. RESULTS The cumulative incidence of SSI after 30 days was 0.49%. The median time from operation to SSI was 7 days (interquartile range, 4-10.5 days). SSI was classified as superficial incisional in 30 cases (93.8%), deep incisional in 1 case (3.1%), and organ/space in 1 case (3.1%). Staphylococcus aureus was the most common isolate. In multivariable analysis, duration of operation (P = .004) and American Society of Anesthesiologists' score (P = .031) were identified as independent risk factors for SSI. These variables formed the basis of a nomogram, which was validated internally by bootstrapping and reached a predictive accuracy of 70.1%. The calibration curve showed a good agreement between predicted probability and actual observation. CONCLUSION The cumulative incidence of SSI in thyroid operation is <0.5%. American Society of Anesthesiologists' score and the duration of operation are independent risk factors for SSI. Antibiotic prophylaxis may be considered for selected patients based on the individual risk profile.
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Affiliation(s)
- Claudia Bures
- Second Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria; Department of Surgery, Kaiserin-Elisabeth-Spital, Vienna, Austria
| | - Tobias Klatte
- Second Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria; Department of Urology, Medical University of Vienna, Vienna, Austria.
| | - Monika Gilhofer
- Department of Pathology and Microbiology with Hospital Hygiene Team, Kaiserin-Elisabeth-Spital, Vienna, Austria; Department of Pathology and Microbiology, Krankenanstalt Rudolfstiftung, Vienna, Austria
| | - Michael Behnke
- Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen, Charité-Universitätsmedizin, Berlin, Germany
| | - Ann-Christin Breier
- Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen, Charité-Universitätsmedizin, Berlin, Germany
| | - Nikolaus Neuhold
- Department of Pathology and Microbiology with Hospital Hygiene Team, Kaiserin-Elisabeth-Spital, Vienna, Austria
| | - Michael Hermann
- Second Department of Surgery, Krankenanstalt Rudolfstiftung, Vienna, Austria; Department of Surgery, Kaiserin-Elisabeth-Spital, Vienna, Austria
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Wound complications and clinical results of electrocautery versus a scalpel to create a cutaneous flap in thyroidectomy: A prospective randomized trial. Surg Today 2011; 41:1041-8. [DOI: 10.1007/s00595-010-4435-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 05/10/2010] [Indexed: 10/18/2022]
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Kamer E, Unalp H, Derici H, Akguner T, Erbil Y, Issever H, Peskersoy M. Flapless conventional thyroidectomy: a prospective, randomized study. Surg Today 2010; 40:1018-22. [PMID: 21046498 DOI: 10.1007/s00595-009-4186-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 10/09/2009] [Indexed: 09/29/2022]
Abstract
PURPOSE Conventional thyroid surgery is one of the most common operations performed worldwide. The conventional technique involves placement of small or large cutaneous flaps. However, the published data regarding flap use for thyroidectomy are contradictory. This study presents the results using a flapless conventional thyroidectomy and the efficacy of this approach in a thyroidectomy. In addition, the study determined whether there are any advantages associated with the use of this approach in comparison to conventional thyroid surgery. METHODS One hundred and forty-two patients underwent a thyroidectomy. The patients were randomly assigned to surgical procedures. Patients in Group 1 (n = 70) underwent a conventional thyroidectomy, and patients in Group 2 (n = 70) underwent a conventional thyroidectomy without a cutaneous flap. RESULTS There was no significant difference between the two groups in terms of age, sex, body mass index, length of incision, gland volume, and length of hospital stay. Postoperative pain was significantly less in Group 2 than in Group 1 (P = 0.006). Patients in Group 2 showed significantly lower requirement for postoperative intravenous analgesic (P = 0.001), and postoperative peroral analgesic (P = 0.023) in comparison to those in Group 1. Incidences of transient vocal cord paralysis and hypocalcemia were 1.4% and 1.4%, respectively. Of 140 patients, 5 (3.6%) developed postoperative wound complications. CONCLUSIONS These results indicate that a flapless thyroidectomy is safe and technically feasible, and therefore could be an alternative to a conventional thyroidectomy.
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Affiliation(s)
- Erdinc Kamer
- Department of General Surgery, Izmir Ataturk Training and Research Hospital, 35360, Basinsitesi, Izmir, Turkey
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