Drainless head and neck surgery: A retrospective review of 156 procedures (thyroidectomy, parotidectomy and neck dissections in a tertiary setting): The Southampton experience

Efficiency Analysis of Hemostatic Agents in Drainless Neck Surgery: Cellulose-Based Versus Liquid Fibrin Sealants

PURPOSE

 Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries. This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries.

METHODS

A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both.

RESULTS

A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001).

CONCLUSION

Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.

Drainless thyroid surgeries including goiter or central neck dissection: a case-control study

BACKGROUND

Despite ample of evidence regarding feasibility of simple drainless thyroid surgeries, the evidence of feasibility of such procedures in goiters and central neck dissections remains limited.

METHODS

Patients undergoing total thyroidectomy (TT) between January 2017 and July 2022 were included. The study included two study groups: drainless TT with central neck dissection (CND) and drainless TT due to goiter, which were compared to two controls: non-goiter drainless TT and drained TT for goiter or with CND. Main outcome was post-operative seroma rate.

RESULTS

156 patients met the inclusion criteria for each of the group. No significant differences between groups were found for permanent hypocalcemia, and other complications. Post-operative seroma was found in nine patients (5.8%), all from study groups. No significant differences between groups were found for local infections, aspirations, post-discharge drain insertion.

CONCLUSIONS

Complex drainless thyroid surgeries, including goiter and CND, are feasible and do not seem to significantly increase rate of post-operative seromas or infections.

Impact of drainless neck dissection on surgical outcome: a matched case-control study

PURPOSE

The safety of drainless lateral neck dissection (ND) remains to be proven. Hereby, we describe outcomes of drainless ND using fibrin sealant (FS).

METHODS

A retrospective, single academic institute, matched cased control. The study group included patients who underwent drainless ND (drainless group), matched to control patients by age, sex, body mass index, laterality and median number of levels dissected. Additional comparison of patients who underwent at least II-IV lateral ND for a thyroid cancer indication was also conducted. Outcomes were post-operative seroma\infections.

RESULTS

A total of 118 patients (42 cases and 76 controls) were included in the study. Groups did not differ in pre-operative characteristics, percentage of bilateral ND, and extension of ND. No significant difference was found in terms of post-operative infections, seroma, aspirations, and post-operative antibiotic use. The additional analysis included 23 drainless lateral ND and matched controls, of which 91% underwent concomitant level V dissection. No significant difference was found in terms of post-operative seroma or infection. These findings were confirmed with a multivariate analysis.

CONCLUSIONS

Drainless ND using FS in non-violating mucosa surgeries appears to be feasible and safe, without significantly increasing post-operative seroma and its associated complications.

Outpatient parotidectomy with or without the use of a post-operative drain: A retrospective bi-institutional study

OBJECTIVE

Parotid surgery is historically performed as an inpatient procedure and suctions drains are predominantly used during surgery. Recent literature provides evidence that outpatient parotid surgery is safe and effective. Our study aims to describe the results of drainless outpatient parotidectomy and outpatient parotidectomy with drain placement and compare their outcomes.

DESIGN

Retrospective cohort study.

SETTING

Bi-institutional retrospective cohort study.

PARTICIPANTS

Patients that underwent outpatient drain-less parotidectomy and patients that underwent outpatient parotidectomy with post-operative drain placement.

MAIN OUTCOME MEASURES

Complication rates, unplanned post-operative visits, unplanned prolonged stay.

RESULTS

Three hundred eighty patients underwent outpatient parotidectomy with drain placement and 31 patients underwent outpatient drainless parotidectomy in two different hospitals. The incidence of haematoma (drain: 3.1% vs. drainless: 0%, p = 1), infection (drain: 14.3% vs. drainless: 13.8%, p = 1) and salivary fistula (drain: 5.6% vs. drainless: 3.4, p = 1) were comparable between both groups. Seroma or sialocele was more frequently seen in the drain-less group (27.6% vs. 6.2%, p < .001), but were all managed conservatively. Within 10 days after surgery, unplanned visits seemed more frequent in the drain group, although the difference was not statistically significant (14.9% vs. 3.4%, p = .16).

CONCLUSIONS

Outpatient parotid surgery with or without the use of a post-operative drain is safe, practical and feasible. Same-day discharge with and without drain placement yield comparable outcomes. However, the results need to be interpreted cautiously as this study was limited by a small cohort of parotidectomies without drain placement. Future studies should further compare both approaches.

Drainless parotidectomy using tissue fibrin sealant - A retrospective case-control study

The aim of this study was to evaluate the impact of drainless parotidectomy using fibrin sealant on length of stay, post-operative seroma and related complications. For this purpose, a retrospective matched case-control series was held in a single academic center. All patients who underwent drainless parotidectomies, including deep lobe tumors and revision surgeries, were compared to matched controls in which a suction drain was inserted. Main outcomes were length of hospital stay and post-operative seroma. A total of 123 patients (41 cases and 82 controls) were included in the study. Fibrin sealant group had higher rates of total parotidectomy compared with the control group (25.0% vs. 10.5%, p = 0.054). Length of stay was significantly shorter in the fibrin sealant group (1.0 ± 0.3 days vs. 1.5 ± 0.6 days, p < 0.001, respectively). No statistically significant difference was found between the fibrin sealant group and the control regarding post-operative seromas (9.8% vs. 14.6%, p = 0.574, respectively), aspirations rate (7.3% vs. 14.6%, p = 0.381), and infection rates (0% vs.3.7%, p = 0.550). In conclusion, drainless parotidectomy does not increase post operative seroma rates and related complications, and can also be implemented for revision surgery.