Selective use of drains in thyroid surgery.

OBJECTIVE: To identify whether there are differences in the use of drains and, if used, which would be the best for thyroid surgery. DESIGN: Prospective, longitudinal, comparative, randomized study. SETTING: General Hospital Mexico City, Mexico. PATIENTS AND METHODS: One hundred fifty patients were studied, divided into three groups: group A, without drain; group B, with a Penrose drain; and group C, with a semirigid suction drain. On the basis of the preoperative diagnosis, subtotal or total thyroidectomy or hemithyroidectomy was performed. Analyzed variables were thyroid volume (TV), transoperative bleeding (TOB), flow of postoperative drain (PD), length of hospital stay (HS), and complications, such as seromas, hematomas, and hemorrhages. Statistical Analysis. Multiple variant analysis, using Scheffe's procedure and chi2. RESULTS: Group A had an average TOB of 107 mL, HS of 2 days, and TV of 153.24 mL with two complications (seromas). Group B had an average TOB of 149.8 mL, HS of 2.6 days, TV of 175.4 mL, PD of 29.6 mL, and three complications (2 seromas and 1 hematoma). Group C had an average TOB of 161.5 mL, HS of 3.11 days, TV of 173.5 mL, PD of 25.84 mL, and two seromas. No differences existed regardless of the type of drain used between groups B and C. CONCLUSION: Statistical analysis showed that the size of the gland, diagnosis, type of surgery, transoperative bleeding, and complications are not valid arguments to leave an external drain in thyroid surgery. No advantages were found between the Penrose or the semirigid suction drains. Hospital stay was longer in patients with the suction drain. These results support the notion that the use of wound drainage cannot substitute for meticulous dissection and transoperative hemostasis.

Syringe pressure irrigation of subdermic tissue after appendectomy to decrease the incidence of postoperative wound infection.

To evaluate syringe pressure irrigation of the surgical wound to decrease its infection after appendectomy, we designed a randomized control trial at the Emergency Department of Mexico City General Hospital, including 350 patients with acute abdomen suggestive of appendicitis, without any other infection clinically evident. The trial was randomized into 2 groups. Group I patients received prophylactic systemic antibiotics before surgery. Group II patients received the same prophylactic systemic antibiotics plus syringe pressure irrigation of the surgical wound with 300 ml of saline solution using a 20-ml syringe with 19-gauge intravenous (IV) catheter to measure the incidence of postoperative wound infection. In our results, 283 patients had appendicitis. Of these, 188 were uncomplicated (66.4%) and 95 (33.6%) were complicated. Of the complicated cases, 40 were assigned to group I, and of these, 29 (72. 5%) developed wound infection. In group II there were 55 patients and only 9 (16.3%) developed wound infection after syringe pressure irrigation [p = 0.000001; 95% confidence interval (CI) = 0.02-0.22]. We conclude that syringe pressure irrigation of the surgical wound after appendectomy contributes significantly to decrease the incidence of postoperative wound infection in complicated cases. It is a cheap, safe, and accessible method in any surgical room.

Irrigación a presión de la herida quirúrgica en apendicitis complicada / Pressure irrigation of the surgical wound in complicated appendicitis

Antecedentes: El objetivo de este estudio fue evaluar la utilidad de la irrigación a presión de la herida quirúrgica para disminuir su infección en enfermos apendicectomizados. Para ello se realizó un ensayo clínico aleatorio en enfermos con apendicitis. Material y métodos: Fueron incluidos 95 enfermos con apendicitis complicada. Los enfermos fueron asignados aleatoriamente a uno de dos grupos: Grupo I:40 pacientes apendicectomizados en los que sólo se empleó antibioticoprofilaxis y grupo II:55 enfermos apendicectomizados en los que además se realizó irrigación a presión de la herida quirúrgica. En ambos grupos se determinó la frecuencia de infección de la herida. Resultados: De los 95 casos incluidos, 67 correspondieron al sexo masculino (70.5 por ciento) y 28 al femenino (29.5 por ciento); la edad promedio fue de 28 años. Veintinueve casos (72.5 por ciento) presentaron infección de la herida quirúrgica en el grupo I y sólo nueve (16 por ciento) en el grupo II; esta diferencia fue estadísticamente significativa (p= 0.000001). Conclusiones: la irrigación a presión de la herida quirúrgica en enfermos con apendicitis complicada contribuye a disminuir la frecuencia de infección de la misma. Es barata, segura y accesible en cualquier quirófano