Complications in thyroid and parathyroid surgery. Retrospective series
Abstract Introduction and objective: Thyroidectomy is one of the most frequent surgical procedures realized worldwide. The incidence of complications is relatively frequent, and on some occasions can be extremely serious, eventhough currently the mortality rate is close to 0%. Method: A review of 400 thyroidectomies, performed by the same surgeon, including total thyroidectomies, hemithyroidectomies and parathyroidectomies from September 2011 to February 2020 has been performed. The most relevant surgical complications (laryngeal paralysis, suffocating hematomas and temporary and permanent hypoparathyroidism) were taken as the main variable, and other variables such as duration of surgery, surgical drainages, time spent in AER, etc. were also analyzed. Results: Of the total of 400 patients who underwent thyroidectomy, 95% (380) had no major surgical complications (asphyxiating hemorrhage, permanent chordal palsy and permanent hypoparathyroidism) and 89% had no complications. There were 5 cases (0,8%) of permanent unilateral chordal palsies and 15 cases of permanent hypoparathyroidism (3.75% of all operated patients and 6,7% of total thyroidectomies). Discussion: The most frequent and important complications are post-surgical hypoparathyroidism, recurrent laryngeal nerve (RLN) injury and suffocating hematoma. Conclusions: Thyroidectomy is a common and safe procedure with a significant decrease in morbidity and mortality in recent decades. However, complications can contribute to a negative impact on the patient´s quality of life. Therefore, it is the surgeon's responsibility to be aware of intraoperative and postoperative problems, as well as to put measures in place for prevention and treatment.
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Fan C, Zhou X, Su G, Zhou Y, Su J, Luo M et al. Risk factors for neck hematoma requiring surgical re-intervention after thyroidectomy: a systematic review and meta-analysis. BMC Surg. 2019; 19 (1):98. Doi: https://doi.org/10.1186/s12893-019-0559-8.
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Harding J, Sebag F, Sierra M, Palazzo FF, Henry J-F. Thyroid surgery: postoperative hematoma prevention and treatment. Langenbecks Arch Surg. 2006; 391 (3): 169-73. Doi: https://doi.org/10.1007/s00423-006-0028-6.
Sun N, Zhang D, Zheng S, Fu L, Li L, Liu S et al. Incidence and risk factors of post-operative bleeding in patients undergoing total thyroidectomy. Front Oncol.2020; 10:1075. Doi: https://doi.org/10.3389/fonc.2020.01075.
Pontin A, Pino A, Caruso E, Pinto G, Melita G, Maria DP et al. Postoperative bleeding after thyroid surgery: care instructions. Sisli Etfal Hastan Tip Bul. 2019; 53 (4): 329-36. Doi: https://doi.org/10.14744/SEMB.2019.95914.
Lale A, Öz B, Akcan AC, Sözüer EM, Arıkan TB, Gök M. Determination of risk factor causing hipocalcaemia afther thyroid surgery. Asian J Surg. 2019; 42(9):883-9. Doi: https://doi.org/10.1016/j.asjsur.2018.12.009.
Jin S, Sugitani I. Narrative review of management of thyroid surgery complications. Gland Surg. 2021;10(3):1135-1146. Doi: https://doi.org/10.21037/gs-20-859.
Gómez-Ramírez J, Heras PC, Jiménez RA, Sáez LDJ, Pineda EY, Syro CZ et al. Large goiters and postoperative complications: ¿does it really matter? Langenbeck's Archives of Surgery. 2023; 408 (1): 213. Doi: https://doi.org/10.1007/s00423-023-02959-5.
Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015; 102(4): 359-67. Doi: https://doi.org/10.1002/bjs.9676.
Sitges-Serra A, Lorente-Poch L, Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Arch Surg. 2018; 403(3):309-15. Doi: https://doi.org/10.1007/s00423-018-1654-5.
Tartaglia F, Blasi S, Giuliani A, Merola R, Livadoti G, Krizzuk D et al. Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg. 2016;28 Suppl 1: 79-83. Doi: https://doi.org/10.1016/j.ijsu.2015.05.059.
Ladurner R, Lerchenberger M, Al Arabi N, Gallwas J, Stepp H, Hallfeldt K. Parathyroid Autofluorescence-How Does It Affect Parathyroid and Thyroid Surgery? A 5 Year Experience. Molecules. 2019; 24 (14):2560. Doi: https://doi.org/10.3390/molecules24142560.
Abbaci M, De Leeuw F, Breuskin I, Casiraghi O, Lakhdar AB, Ghanem W et al. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: A systematic review. Oral Oncol. 2018; 87:186-96. Doi: https://doi.org/10.1016/j.oraloncology.2018.11.011.
Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D et al. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: ¿Is it the surgeon who pays the bill. Int J Surg.2017;41 Suppl 1: 55-9. Doi: https://doi.org/10.1016/j.ijsu.2017.01.112.
Kaisha W, Wobenjo A, Saidi H. Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans. Clin Anat. 2011; 24 (7):853-7. Doi: https://doi.org/10.1002/ca.21192.
Bakalinis E, Makris I, Demesticha T, Tsakotos G, Skandalakis P, Filippou D. Non-Recurrent Laryngeal Nerve and Concurrent Vascular Variants: A Review. Acta Med Acad. 2018; 47 (2):186-92. Doi: https://doi.org/10.5644/ama2006-124.230.
Gómez-Ramírez J, Heras PC, Jiménez RA, Saez LDJ, Pineda EY, Syro CZ et al. Large goiters and postoperative complications: ¿does it really matter?. Langenbeck's Arch Surg. 2023; 408 (1):213. Doi: https://doi.org/10.1007/s00423-023-02959-5.
Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg. 2013; 83 (1-2):15-21. Doi: https://doi.org/10.1111/j.1445-2197.2012.06247.x.
Polychronidis, G. Hüttner FJ, Contin P, Goossen K, Uhlmann L, Heidmann M et al. Network meta-analysis of topical haemostatic agents in thyroid surgery. Br J Surg. 2018; 105 (12): 1573-1582. Doi: https://doi.org/10.1002/bjs.10975.
Galluzzi F, Garavello W. Complications of revision surgery in case of bleeding after thyroid surgery: A systematic review. Eur Ann Otorhinolaryngol Head Neck Dis. 2023; 140 (4): 171-6. Doi: https://doi.org/10.1016/j.anorl.2023.01.002.
Harding J, Sebag F, Sierra M, Palazzo FF, Henry J-F. Thyroid surgery: postoperative hematoma prevention and treatment. Langenbecks Arch Surg. 2006; 391 (3): 169-73. Doi: https://doi.org/10.1007/s00423-006-0028-6.
Sun N, Zhang D, Zheng S, Fu L, Li L, Liu S et al. Incidence and risk factors of post-operative bleeding in patients undergoing total thyroidectomy. Front Oncol.2020; 10:1075. Doi: https://doi.org/10.3389/fonc.2020.01075.
Pontin A, Pino A, Caruso E, Pinto G, Melita G, Maria DP et al. Postoperative bleeding after thyroid surgery: care instructions. Sisli Etfal Hastan Tip Bul. 2019; 53 (4): 329-36. Doi: https://doi.org/10.14744/SEMB.2019.95914.
Lale A, Öz B, Akcan AC, Sözüer EM, Arıkan TB, Gök M. Determination of risk factor causing hipocalcaemia afther thyroid surgery. Asian J Surg. 2019; 42(9):883-9. Doi: https://doi.org/10.1016/j.asjsur.2018.12.009.
Jin S, Sugitani I. Narrative review of management of thyroid surgery complications. Gland Surg. 2021;10(3):1135-1146. Doi: https://doi.org/10.21037/gs-20-859.
Gómez-Ramírez J, Heras PC, Jiménez RA, Sáez LDJ, Pineda EY, Syro CZ et al. Large goiters and postoperative complications: ¿does it really matter? Langenbeck's Archives of Surgery. 2023; 408 (1): 213. Doi: https://doi.org/10.1007/s00423-023-02959-5.
Lorente-Poch L, Sancho JJ, Ruiz S, Sitges-Serra A. Importance of in situ preservation of parathyroid glands during total thyroidectomy. Br J Surg. 2015; 102(4): 359-67. Doi: https://doi.org/10.1002/bjs.9676.
Sitges-Serra A, Lorente-Poch L, Sancho J. Parathyroid autotransplantation in thyroid surgery. Langenbecks Arch Surg. 2018; 403(3):309-15. Doi: https://doi.org/10.1007/s00423-018-1654-5.
Tartaglia F, Blasi S, Giuliani A, Merola R, Livadoti G, Krizzuk D et al. Parathyroid autotransplantation during total thyroidectomy. Results of a retrospective study. Int J Surg. 2016;28 Suppl 1: 79-83. Doi: https://doi.org/10.1016/j.ijsu.2015.05.059.
Ladurner R, Lerchenberger M, Al Arabi N, Gallwas J, Stepp H, Hallfeldt K. Parathyroid Autofluorescence-How Does It Affect Parathyroid and Thyroid Surgery? A 5 Year Experience. Molecules. 2019; 24 (14):2560. Doi: https://doi.org/10.3390/molecules24142560.
Abbaci M, De Leeuw F, Breuskin I, Casiraghi O, Lakhdar AB, Ghanem W et al. Parathyroid gland management using optical technologies during thyroidectomy or parathyroidectomy: A systematic review. Oral Oncol. 2018; 87:186-96. Doi: https://doi.org/10.1016/j.oraloncology.2018.11.011.
Gambardella C, Polistena A, Sanguinetti A, Patrone R, Napolitano S, Esposito D et al. Unintentional recurrent laryngeal nerve injuries following thyroidectomy: ¿Is it the surgeon who pays the bill. Int J Surg.2017;41 Suppl 1: 55-9. Doi: https://doi.org/10.1016/j.ijsu.2017.01.112.
Kaisha W, Wobenjo A, Saidi H. Topography of the recurrent laryngeal nerve in relation to the thyroid artery, Zuckerkandl tubercle, and Berry ligament in Kenyans. Clin Anat. 2011; 24 (7):853-7. Doi: https://doi.org/10.1002/ca.21192.
Bakalinis E, Makris I, Demesticha T, Tsakotos G, Skandalakis P, Filippou D. Non-Recurrent Laryngeal Nerve and Concurrent Vascular Variants: A Review. Acta Med Acad. 2018; 47 (2):186-92. Doi: https://doi.org/10.5644/ama2006-124.230.
Gómez-Ramírez J, Heras PC, Jiménez RA, Saez LDJ, Pineda EY, Syro CZ et al. Large goiters and postoperative complications: ¿does it really matter?. Langenbeck's Arch Surg. 2023; 408 (1):213. Doi: https://doi.org/10.1007/s00423-023-02959-5.
Hayward NJ, Grodski S, Yeung M, Johnson WR, Serpell J. Recurrent laryngeal nerve injury in thyroid surgery: a review. ANZ J Surg. 2013; 83 (1-2):15-21. Doi: https://doi.org/10.1111/j.1445-2197.2012.06247.x.
Polychronidis, G. Hüttner FJ, Contin P, Goossen K, Uhlmann L, Heidmann M et al. Network meta-analysis of topical haemostatic agents in thyroid surgery. Br J Surg. 2018; 105 (12): 1573-1582. Doi: https://doi.org/10.1002/bjs.10975.
Torres-Morientes, L. M., Tamayo-Gómez, E., Peciña-Melgosa, P., Muñoz-Moreno, M. F., Fernández-Rodríguez, A., & Santos-Pérez, J. (2024). Complications in thyroid and parathyroid surgery. Retrospective series. Revista ORL, 15(4), e31749. https://doi.org/10.14201/orl.31749
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