# Efficiency Analysis of Hemostatic Agents in Drainless Neck Surgery: Cellulose-Based Versus Liquid Fibrin Sealants

## TL;DR

This study compared the effectiveness of different hemostatic agents in surgeries without drains and found no significant advantage for either cellulose-based or liquid fibrin sealants.

## Contribution

The study provides new evidence on the comparative efficacy of hemostatic agents in drainless neck surgeries.

## Key findings

- Drain placement reduced seroma formation but delayed patient discharge by at least one day.
- No significant advantage was found between cellulose-based and liquid fibrin sealants in drainless surgeries.
- Combining both hemostatic agents did not improve outcomes compared to using either alone.

## Abstract

Purpose: Using liquid fibrin sealants has once again questioned the benefit of drain placement in head and neck operations. Cellulose-based hemostats offering different hemostasis mechanisms have scarcely been investigated in drainless neck surgeries. This study aimed to evaluate whether liquid fibrin sealant offers any advantage over cellulose-based hemostats in various head and neck surgeries.

Methods: A prospective trial of patients who underwent various neck surgeries between 2020 and 2022. Baseline characteristics and postoperative outcomes were compared between the drain-placed and the drainless groups, with the latter sub-categorized into three groups: fibrin sealant, cellulose-based hemostats, and a combination of both.

Results: A total of 119 patients were included (63 thyroidectomies, 40 parathyroidectomies, and 16 sialoadenectomies). Fifty eight had a drain placed and 61 had no drain. In the drainless group, 23 patients received cellulose-based absorbable hemostats (SURGICEL®/ FIBRILLAR™); 18 patients had fibrin sealants (EVICEL®/TachoSil®/TISSEEL); in 16, a combination of both was used; and in four patients, no hemostatic agent was used. Three (5%) of the 61 drainless patients developed a seroma compared to one (2%) seroma in the drain-placed patients. No advantage was demonstrated using a combination of FIBRILLAR™ with a fibrin sealant nor for any used separately. Drain placement delayed patient discharge by at least one day compared to the group without a drain (p < 0.001).

Conclusion: Drain placement offered a minor advantage in the postoperative course reducing rates of seroma formation, while delaying patient discharge by at least one day. There was no advantage in using a specific hemostatic agent over the other.