Drains in thyroid surgery: Are they still necessary?

Drainage in thyroid surgery has been a routine but empirical practice with no scientific evidence to support its benefit. A retrospective review of a personal series of 1789 thyroidectomies over a 3 1/2-year period was conducted. Except for thyroid cancer surgery with lymphadenectomy and large mediastinal goiters requiring sternotomy, no case selection 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 occurred 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 experience, drainage after thyroid surgery may not mandatory provided that the field is completely dry before closure. We therefore, progressively modified our operative strategy in order to improve a meticulous haemostatic technique, considered to be more important than the use of drains. Meticulous surgical technique and obliteration of dead space led us to observe a dramatic decrease of the incidence of hemorrhagic complications, eliminating the need for systematic drainage after thyroid surgery.