The routine insertion of drains after total thyroidectomy by harmonic scalpel , is it always necessary ?

* Department of Surgery, College of Medicine, Hawler Medical University, Erbil, Iraq. Introduction Traditionally many surgeons advocate draining the neck routinely after thyroid surgery. Although several prospective randomized reports regarding the function of the drains in thyroid surgery have not justified their use, most surgeons still employ routine drainage of the thyroidectomy bed. The main reason proposed for the drainage is to avoid wound hematoma and seroma and, therefore, prevent the resulting airway compression and obstruction. This belief is further reinforced by the fact that the postoperative drains usually yield fluid. However, a common problem is that the drains become blocked with clotted blood and are useless in alerting the surgeon even if a major bleeding occurs, and studies failed to show that placement of drain prevents the hematoma formation. There are very low chances of postoperative seromas forming in the absence of drains but they can be observed and allowed to resorb themselves or, if severe, aspirated. The harmonic scalpel uses high frequency mechanical energy to cut and coagulate tissues and vessels simultaneously without the need for knot tying. The effectiveness and efficacy of the harmonic scalpel in thyroid surgery have been sufficiently demonstrated in the literature. This technique is associated with a significantly lower overall incidence of complications with a statistically significant reduction of cases of postoperative bleeding and seroma. The debate on the necessity of drains after thyroid surgery is compounded by the belief that they can cause severe Background and objective: Routine use of drains after thyroidectomy is not evidence based; nevertheless most surgeons use drains to alert them to the presence of postoperative bleeding and for the prevention of hematoma and seroma. This comparative study was conducted to evaluate the necessity of routine drainage after total thyroidectomy. Methods: A total of 150 patients who underwent total thyroidectomy due to different indications at different hospitals in Erbil city, Iraq from June 2011 to December 2015, were included. A retrospective comparison was made between those drained (group 1) and those without drain (group 2). Operating time, postoperative complications and hospital stay were assessed. Results: Operation time was significantly less in group 2 compared to group 1; 64.9 ± 7.64 minutes versus 73.8 ± 9.81 minutes, respectively. There was no statistically significant difference in the incidence of postoperative complications. Only two patients, both from group 1, developed a postoperative hematoma. Wound infection occurred only in 2 patients in group 1. Hospital stay was significantly shorter in group 2 compared to group 1; 21.1 ± 3.98 hours versus 41.7 ± 8.64 hours, respectively. Conclusion: The routine use of drain is not necessary after total thyroidectomy; it increases the hospital stay and may increase the rate of postoperative sepsis.