Drain-free parotidectomy: a pilot study using ARTISS fibrin sealant

• Published in: European archives of oto-rhino-laryngology 2019-07, Vol.276 (7), p.2025-2029
• Main Authors: Cunniffe, H. A., Wong, B. L. K., Hilger, A. W., Burgan, O. T.
• Format: Article
• Language: English
• Subjects: Adult; Ambulatory Surgical Procedures - economics; Ambulatory Surgical Procedures - methods; Cost Savings; Female; Fibrin Tissue Adhesive - therapeutic use; Fibrinogen - pharmacology; Head & Neck; Head and Neck Surgery; Hematoma - etiology; Hematoma - prevention & control; Hemostatics - pharmacology; Humans; Male; Medicine; Medicine & Public Health; Middle Aged; Neurosurgery; Otorhinolaryngology; Parotid Diseases - pathology; Parotid Diseases - surgery; Parotid Gland - surgery; Pilot Projects; Postoperative Complications - prevention & control; Retrospective Studies; Seroma - etiology; Seroma - prevention & control; United Kingdom
• ISSN: 0937-4477; 1434-4726
• DOI: 10.1007/s00405-019-05449-x

Purpose Parotidectomy is the definitive procedure for diagnosis and treatment of most parotid masses but, due to the risk of haematoma and seroma formation, has traditionally included a drain. The drain itself comes with its own risks and, in most hospitals, the need for overnight admission, which has significant cost implications (Mallon et al. Ann R Coll Surg Engl 95(4):258–262; 2013 ). Fibrin glue, with its haemostatic and adhesive properties, reduces the risk of collection or haematoma and therefore may negate the need for a drain. This is the first study to look at the use of ARTISS as an alternative to drains in parotidectomy. Methods We performed a retrospective study of all the patients who underwent a partial parotidectomy over a 4-year period from 2014 until 2018 under the same senior surgeon. Patients were divided into those that had a drain and those that had ARTISS. Their operative record, inpatient notes and clinic letters were reviewed to record information regarding length of stay, histology, complications and recurrence. Results A total of 34 patients were identified; 17 ARTISS and 17 drain patients. We showed that the mean length of stay improved significantly from 1.6 days with the drain to 0.5 days with ARTISS (Fig.  1 ) but without a difference in complication rate (Fig.  2 ), which was 5/17 (29%) in each group. Conclusions In conclusion, parotidectomy can be undertaken safely as a day-case procedure with the application of ARTISS. This new approach to parotid surgery not only offers less morbidity for patients but also positive financial revenue for public health institutions.