How is postoperative thyroid surgery bleeding prevented?

Updated: Jan 25, 2018
  • Author: Pramod K Sharma, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Answer

Sound surgical technique is essential. The thyroid is a highly vascular organ and bleeds copiously. Therefore, care must be taken to avoid traumatizing the thyroid tissue during the procedure. The prevention of postoperative bleeding depends on good intraoperative hemostasis. Hemostasis in thyroid surgery is achieved by means of clamp and tie, surgical clips, diathermy, ultrasonic coagulating-dissection such as a harmonic scalpel (HS) or electrothermal bipolar vessel sealing systems (EBVSS). Before closing the wound, irrigate it well and address all residual bleeding. Finally, avoid the use of neck dressings. A dressing that covers the wound may mask hematoma formation, delaying its recognition.

Controversy still surrounds the use of drains after thyroid surgery. The authors do not advocate the postoperative use of drains (active or passive). Results of several prospective studies have disputed the usefulness of drains.

Schoretsanitis et al (1998) randomly assigned 200 patients undergoing thyroidectomy into 2 groups. [6] One group received a suction drain at the time of surgery, whereas the other did not; hematomas occurred in 5% and 7%, respectively. Two (2%) patients without drains and 1 (1%) with a drain required exploration for vascular ligation. Neither of these differences was statistically significant. Schoretsanitis et al (1998) also reported that the postoperative hospitalization time was longer in the patients with drains (3.4 vs 1.6 d), as was the duration of postoperative pain. [6]

Debry et al (1999) prospectively evaluated the usefulness of drains after thyroidectomy in a randomized trial for 100 patients. [7] Four patients, all of whom received drains, developed hematomas.

No definitive evidence suggests that drains prevent hematoma or seroma formation. If a drain is placed, its use should not substitute for intraoperative hemostasis. Nonsuction drainage is not recommended because it increases the infection risk and the need for neck dressings. These dressings obstruct the view of the neck and may delay diagnosis of a hematoma.


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