Indications and Morbidity of Reoperative Thyroid Surgeries in a Military Hospital of Senegal.

Abdou Sy,Yves Diandy,Malick Ndiaye,Eric Joël Regonne,Aminata Fofana

doi:10.1155/2017/4045617

Abstract

Objectives To describe reoperative thyroid surgeries in our department. Study Design Retrospective cross-sectional and descriptive study at the Ouakam Military Hospital in Dakar (Senegal), over a period of eight and a half years. Methods The study involved all records of patients who had a reoperative thyroidectomy regardless of the indication and time of the second surgery. Parameters evaluated for first and reoperative surgery were time interval between the two surgeries, operative indications, surgical procedures, intraoperative findings, pathological examination, and morbidity. Results 30 records of patients were selected out of a total of 698 thyroidectomies (4.3%). Thyroid cancers diagnosed on first surgical specimens were the first indications of reoperations (46.67%) followed by neck hematoma (20%). Completion thyroidectomy with a prophylactic central lymph nodes dissection was the most performed surgical procedure (43.33%) followed by haemostasis (20%). During reoperation, we found active bleeding (20%), textiloma (6.67%), and fourth branchial cleft fistula (3.33%). The morbidity accounted for 10%: lymphorrhea, permanent hypocalcemia, and permanent recurrent nerve palsy, in one case, respectively. There were no statistically significant differences between the morbidity in patients reoperated on and the one for patients operated on once. Conclusion We did not find an increased risk of postoperative morbidity after reintervention.

Highlights

Reoperative thyroidectomy is a rare surgical procedure
Its main indications are thyroid cancers diagnosed on specimen of lobectomy with isthmusectomy or subtotal thyroidectomy, recurrence of thyroid cancers and benign goitres, and neck hematoma
We defined reoperative thyroidectomy as any surgery on the thyroid bed that required a return to the operating room for reoperation either to complete the first surgery or in relation to a complication related to the first surgery

Summary

Introduction

Reoperative thyroidectomy is a rare surgical procedure. Its frequency in the literature varies from 4.7 to 7.5% [1,2,3,4]. Its main indications are thyroid cancers diagnosed on specimen of lobectomy with isthmusectomy or subtotal thyroidectomy, recurrence of thyroid cancers and benign goitres, and neck hematoma. It is a surgical procedure which exposes the patient to a risk of recurrent laryngeal nerve and parathyroid injury, due to fibrosis and anatomical changes, the consequences of the previous intervention on the thyroid bed. The objectives of our study were to describe the indications for reoperative thyroid surgeries, to determine the incidence of postoperative complications, and to compare them with thyroidectomies performed during the same period in our department Some authors find that the incidence of postoperative complications after reoperative thyroidectomy is significantly greater than after a first thyroidectomy [4, 5], while others find that there are none [6, 7].

Objectives

Methods

Conclusion