CHALLENGE THYROIDECTOMY MANUAL DELIVERY VERSUS STERNOTOMY IN RETROSTERNAL GOITER

Abstract

The study was carried out on 40 patients presented with thyroid swelling admitted at KobryEl-Kobba Military Medical Compass over two years. Eighteen of them suffered from retrosternalgoiter and were divided into two groups. GI: 4 males were treated by sternotomy andtotal thyroidectomy, which histopathological examination showed multinodular goiter. GII: 14patients (12 males & 2 females) were treated by cervical incision and manual retrosternal goiterdeli- very. Patients in both groups were followed up 2 weeks over three months and thenone month over a year post-operation for thyroid profile, serum Ca level, and histopathologicalspecimens showed multinodular goiter without malignancy.In GI, one patient developed wound secondary infection and was treated by antibiotic. Anotherone showed post-operative hypocalcemia and was treated by oral vitamin D and Ca 500mg and improved after 6 months. In GII, six male patients showed complications; two showedtransient hypocalcemia post-operative and were treated by I.V. Ca gluconate 10% every 12hrfor 2 days followed by oral Ca every 12hr for another week and then one vitamin D and oneCa- tablet for 6 months. One patient showed neck hematoma and exploration was done toevacuate hematoma and bleeding control. Two patients showed nerve problem in the form ofvoice change, difficult in swallowing and aspiration. One was managed by endotracheal intubationfor 48hr and the second was managed by Oxygen therapy and steroid. One patientshowed mild infection and skin edema that was managed by antibiotic and anti-edematousagent. The last one showed sinus formation and was treated by curettage and antibiotic. Thehospital stay was long in GI than in GII, as in GI 48hr ventilation used post-operative comparedto 24hr in GII, but neither tracheomalacia treatment nor tracheostomy in both groups.