Scar formation and patient satisfaction after thyroidectomy with and without surgical drains

Authors

  • Hyo Young Kim Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, South Korea
  • Ho Seong Kim Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, South Korea
  • Hong Il Kim Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, South Korea
  • Jin Hyung Park Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, South Korea
  • Hyung Suk Yi Department of Plastic and Reconstructive Surgery, Kosin University College of Medicine, Busan, South Korea

DOI:

https://doi.org/10.18203/2349-2902.isj20193309

Keywords:

Thyroidectomy, Drain, Scar, Patient satisfaction

Abstract

Background: Several comparative studies have documented the outcomes of negative pressure drain use after thyroidectomy. However, these previous studies did not focus on scar formation. The aim of this study was to compare thyroidectomy outcomes with and without negative pressure drain use in terms of scar formation.

Methods: Nine hundred seventy-five patients who underwent thyroidectomy between January 2012 and December 2013, at Kosin University Gospel Hospital were enrolled in this study. Patients were assigned to one of two groups at the surgeon's discretion: the negative pressure drain group (n=515) or the no drain group (n=460). Medical records were reviewed, and the incidence and severity of scar formation were compared. We estimated patient satisfaction seven months postoperatively based on aesthetic and functional outcomes using the patient and observer scar assessment scale.

Results: The incidence of mild scarring was higher in the no drain group, but this difference was not statistically significant (p=0.069). The incidence of severe scarring was significantly higher in the negative pressure drain group (5.83%, p<0.001). Based on the patient and observer scar assessment scale data from 205 patients, patient satisfaction was significantly higher in the no drain group (p=0.006). Itching was reported significantly less frequently in the no drain group (p=0.034). There were no significant differences between groups with respect to pain or observer scar scale score.

Conclusions: This study suggests that not using a drain after thyroidectomy leads to high patient satisfaction and reduces the likelihood of severe scar formation.

References

Defechereux T, Hamoir E, Nguyen Dang D, Meurisse M. Drainage in thyroid surgery. Is it always a must? Ann Chir. 1997;51:647–52.

Colak T, Akca T, Turkmenoglu, 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.

Bergqvist D, Kallero S. Reoperation for postoperative haemorrhagic complication. Analysis of a 10-year series. Acta Chirurgica Scandinavica. 1985;151:17-22.

Karayacin K, Besı´m H, Ercan F, Hamamci O, Korkmaz A. Thyroidectomy with and without drains. East Afr Med J. 1997;74:431–2.

Ruark DS, Abdel-misih RZ. Thyroid and parathyroid surgery without drains. Head Neck 1992;14:285–7.

Peix JL, Teboul F, Feldman H, Massard JL. Drainage after thyroidectomy: a randomized clinical trial. Int Surg. 1992;77:122–4.

Ariyanayagam DC, Naraynsingh V, Busby D, Sieunarine K, Raju G, Jankey N. Thyroid surgery without drainage: 15 years of clinical experience. J R Coll Surg Edinb. 1993;38:69–70.

Teboul F, Piex JL, Guibaud L, Massard JL, Ecochard R. Prophylactic drainage after thyroidectomy: a randomized trial. Ann Chir. 1992;46:902–4.

Kristoffersson A, Sandzen B, Jarhult J. Drainage in uncomplicated thyroid and parathyroid surgery. Br J Surg. 1986;73:121–2.

Schwarz W, Willy C, Ndjee C. Gravity or suction drainage in thyroid surgery? Control of efficacy with ultrasound determination of residual hematoma. Langenbecks Arch Chir. 1996;381:337–42.

Lee SW, Choi EC, Lee YM, Lee JY, Kim SC, Koh YW. Is lack of placement of drains after thyroidectomy with central neck dissection safe? A prospective, randomized study. Laryngoscope. 2006;116:1632-5.

Tian J, Li L, Liu P, Wang X. Comparison of drain versus no-drain thyroidectomy: a meta-analysis. Eur Arch Otorhinolaryngol. 2017;274(1):567-77.

Corsten M, Johnson S, Alherabi A. Is suction drainage an effective means of preventing hematoma in thyroid surgery? A meta-analysis. J Otolaryngol. 2005;34:415-7.

Suslu N, Vural S, Oncel M, Demirca B, Gezen FC, Tuzun B, et al. Is the insertion of drains after uncomplicated thyroid surgery always necessary? Surg Today. 2006;36:215-8.

Woo SH, Kim JP, Park JJ, Shim HS, Lee SH, Lee HJ, et al. Comparison of natural drainage group and negative drainage groups after total thyroidectomy: prospective randomized controlled study. Yonsei Med J. 2013;54:204-8.

Ji YB, Song CM, Bang HS, Lee SH, Park YS, Tae K. Long-term cosmetic outcomes after robotic/endoscopic thyroidectomy by a gasless unilateral axillo-breast or axillary approach. J Laparoendosc Adv Surg Tech A. 2014;24:248–53.

Jeong JJ, Kang SW, Yun JS, Sung TY, Lee SC, Lee YS, et al. Comparative study of endoscopic thyroidectomy versus conventional open thyroidectomy in papillary thyroid microcarcinoma patients. J Surg Oncol. 2009;100:477–80.

Miccoli P, Berti P, Raffaelli M, Materazzi G, Baldacci S, Rossi G. Comparison between minimally invasive video-assisted thyroidectomy and conventional thyroidectomy: a prospective randomized study. Surgery. 2001:130:1039–43.

Liu J, Song T, Xu M. Minimally invasive video-assisted versus conventional open thyroidectomy: a systematic review of available data. Surg Today. 2012;42:848–56.

Liu S, Qiu M, Jiang DZ, Zheng XM, Zhang W, Shen HL, et al. The learning curve for endoscopic thyroidectomy: a single surgeon’s experience. Surg Endosc Other Interv Tech. 2009;23:1802–6.

Shaha AR, Jaffe BM. Selective use of drains in thyroid surgery. J Surg Oncol. 1993;52:241–3.

Wax MK, Valiulis AP, Hurst MK. Drains in thyroid and parathyroid surgery. Are they necessary? Arch Otolaryngol Head Neck Surg. 1995;121:981–3.

Woods RSR, Woods JFC, Duignan ES, Timon C. Systematic review and meta-analysis of wound drains after thyroid surgery. Br J Surg. 2014;101:446-56.

van de Kar AL, Corion LU, Smeulders MJ, Draaijers LJ, van der Horst CM, van Zuijlen PP. Reliable and feasible evaluation of linear scars by the Patient and Observer Scar Assessment Scale. Plast Reconstr Surg. 2005;116:514-22.

Kim HY, Kim JW, Park JH, Kim JH, Han YS. Personal Factors that Affect the Satisfaction of Female Patients Undergoing Esthetic Suture after Typical Thyroidectomy. Arch Plast Surg. 2013;40:414-24.

van Zuijlen PP, Angeles AP, Kreis RW, Bos KE, Middelkoop E. Scar assessment tools: Implications for current research. Plast Reconstr Surg. 2002;109:1108-22.

Powers PS, Sarkar S, Goldgof DB, Cruse CW, Tsap LV. Scar assessment: current problems and future solutions. J Burn Care Rehabil. 1999;20:54-60.

Scott JR, Muangman P, Gibran NS. Making sense of hypertrophic scar: a role for nerves. Wound Repair Regen 2007;15:S27–S31.

Lorenz P, Sina BA. Scar prevention, treatment, and revision. Chapter 16. In: Neligan PC (ed), Plastic surgery. 3rd edition. Elservier; 2013: 297-318.

Sandulache VC, Parekh A, Li-Korotky H, et al. Prostaglandin E2 inhibition of keloid fibroblast migration, contraction, and transforming growth factor (TGF)-beta1-induced collagen synthesis. Wound Repair Regen. 2007;15:122–33.

Elfenbein DM, Schneider DF, Chen H, Sippel RS. Surgical site infection after thyroidectomy: a rare but significant complication. J Surg Res. 2014;190:170-6.

Bures C, Klatte T, Gilhofer M, Behnke M, Breier AC, Neuhold N, et al. A prospective study on surgical-site infections in thyroid operation. Surgery. 2014;155:675-81.

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Published

2019-07-25

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Original Research Articles