Discussion
In a retrospective study on 2 cohorts of patients of routine drainage vs
no drainage following conventional SS, Coniglio et al [7] showed
that the seroma rate was higher in the no drainage arm, 3.8% and 9.5%
respectively, if tissue sealant is not administered to both arms.
Although the difference is not statistically significant, it may well be
due to inadequate power of sample size.
In a randomized controlled trial, Maharaj et al [8] demonstrated
that adding tissue sealant for parotidectomy will reduce drain output
which suggests that tissue sealant is a potential substance for the
success of drainless parotidectomy. Duffin et al [9], in a
retrospective study comparing tissue sealant alone vs tissue sealant
plus drainage, there is less hematoma in former arm while the seroma
rate is similar. The results indicate that drainage might not be
necessary if tissue sealant is given.
Our series supports the concept of drainless parotidectomy if tissue
sealant is administered. This is a homogenous series of consecutive
patients who underwent minimally invasive parotidectomy (PP or ECD) with
a standard of surgical technique for benign parotid nodules. However,
the sample size is small. Nevertheless, there is no single incidence of
seroma formation. We fully understand the small size of our series and
therefore we shall continue to recruit more cases in order to illustrate
a robust benefit of tissue sealant. Unfortunately, COVID-19 pandemic has
suspended many elective operations, including parotidectomy.
Tissue sealant is not the single reason to achieve drainless
parotidectomy when other parameters are factored in. From our
experience, transformation of SS to PS / ECD, as well as retrograde
facial nerve dissection will also contribute to the success by
diminishing the dead space through less extensive surgery [3],
[4]. Similarly, parotidectomy under local anesthesia will facilitate
day surgery [5], [6].
To conclude, employment of tissue sealant in parotidectomy is safe and
appears to obviate routine usage of drainage. This will enhance the
practice of day surgery. We shall continue to recruit more cases to
validate the benefit in a larger series.