DRAINS IN THYROID-SURGERY - ARE THEY STIL L NECESSARY

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. A retrospective re view of a personal series of 1789 thyroidectomies over a 3 1/2-year pe riod was conducted. Except for thyroid cancer surgery with lymphadenec tomy and large mediastinal goiters requiring sternotomy, no case selec tion for nondrainage was employed. Patients were stratified only on a chronological basis, according to whether they were drained (n = 575, 1993-1994) or not drained (n = 1214, 1994-1996). Both series included toxic goiters, large plunging compressive goiters, bilateral and redo procedures. Severe lifethreatening hematoma requiring reexploration oc curred in 5 drained patients (0.9%) and in 5 undrained patients (0.4%) . Minor postoperative wound hematoma were conservatively treated in 17 drained patients (2.9%) and 6 undrained patients (1.3%). In our exper ience, drainage after thyroid surgery may not mandatory provided that the field is completely dry before closure. We therefore, progressivel y modified our operative strategy in order to improve a meticulous hae mostatic technique, considered to be more important than the use of dr ains. Meticulous surgical technique and obliteration of dead space led us to observe a dramatic decrease of the incidence of hemorrhagic com plications, eliminating the need for systematic drainage after thyroid surgery.