Title: Reoperative Thyroid Surgery - Our Experience

Authors: Dr S. Zahir Hussain, Dr M.P. Kumaran

 DOI:  https://dx.doi.org/10.18535/jmscr/v4i10.93

Abstract

 Aim: Reoperative thyroid surgery is not an uncommon operation. It is associated with a higher rate of complication; we prospectively analysed 53 patients who had reoperative surgery for recurrent goiter.

 Method: 60 patients had a thyroid reoperation for recurrentmultinodular goiter (48 patients), recurrent thyrotoxicosis (9) or suspected malignancy (3); bilateral lobectomy (36 patients), unilateral lobectomy (24 patients)

 Results: After unilateral surgery we had only 3 patients of transienthypoparathyroidism (%) and 1 trasient recurrent laryngeal nerve palsy (%),after bilateral surgery wehad 10patients of transient hypoparathyr-oidism (%), 1 of definitive (%), 6 of transient recurrent laryngeal nerve palsy (%),and 1 of postoperative bleeding (%).

Conclusions: Reoperative thyroid surgery is a technical challenge with a high incidence of complications. Scarring of the tissues together with distortion of the landmarks make reoperative surgery difficult. A higher risk of complications is described when previous surgery has been performed on both sides. Total thyroidectomy should be considered the procedure of choice for benign multi nodulargoiter eliminating the potential of a reoperation. Subtotal thyroidectomy should therefore no longer be recommended in the management of multinodulargoitre. When ever necessary, reoperative thyroidectomy may be performed safely with little morbidityin experienced hands.

References

1.      Colak T, Akca T, Kanik A, Yapici D, Aydin S. Total versus sub-total thyroidectomy for the management of benign multinodulargoiter in an endemic region. ANZ J Surg 2004;74:974-8.

2.      Gibelin H, Sierra M, Mothes D, Ingrand P, Levillain P, Jones C,Hadjadj S, Torremocha F, Marechaud R, Barbier J, KraimpsJL.Risk Factors for Recurrent Nodular Goiter after Thyroidectomy for Benign Disease: Case-control Study of 244 Patients. WorldJ Surg 2004;28:1079-82.

3.      Terris DJ, Khichi S, Anderson SK, Seybt MW. Reoperative thyroidectomy for benign thyroid disease. Head Neck 2010;32:285-9.

4.      Ambrosi A, Pezzolla A, Barone G, Quaranta G, Errico D, Iacobone M, Ciampolillo A, Triggiani V. Studio clinicodellafunzione residua e dellereci-dive in pazientioperati di tiroidectomiep-arziali per strumanodulareeutiroideo. Ann ItalChir1994;65:543-6.

5.      Bellantone R, Lombardi CP, Boscherini M, Raffaelli M, TondoloV, Alesina PF, Corsello SM, Fintini D, Bossola M. Predictive factors for recurrence after thyroid lobectomy for unilateral non-toxic goiter in an endemic area: Results of a multivariate analysis. Surgery 2004; 136:1247-51.

6.      Calò PG, Tuveri M, Pisano G, Tatti A, Medas F, Donati M, Nicolosi A. Il gozzorecidivo. Nostra esperienza. ChirItal 2009;61:545-9.

7.      Menegaux F, Turpin G, Dahman M, Leenhardt L, ChadarevianR, Aurengo A, Du Pasquier L, Chigot JP. Secondary thyroidectomy in patients with prior thyroid surgery for benign disease:A study of 203 cases. Surgery 1999;125:479-83.

8.      Moalem J, Suh I, Duh QY. Treatment and Prevention of Recurrence of Multinodular Goiter: An Evidence-based Review ofthe Literature. World J Surg 2008;32:1301-12.

9.      Torre GC, Borgonovo G, Arezzo A, Bruzzone D, Ansaldo GL,Puglisi M, Mattioli FP. Il gozzorecidivato: analisi di 134 interventi. Ann ItalChir 1996;67:357-63.

10.  Lefevre JH, Tresallet C, Leenhardt L, Jublanc C, Chigot JP, Menegaux F. Reoperative surgery for thyroid disease. LangenbecksArch Surg 2007;392:685-91.

11.  Shaha AR. Revision Thyroid Surgery – Technical Considerations.OtolaryngolClin N Am 2008;41:1169-83.

12.  Trimboli P, Condorelli E, Catania A, Sorrenti S. Clinical and ultrasound param-eters in the approach to thyroid nodules cytologically classified as indeterminate neoplasm. Diagn Cytopathol 2009;37:783-5.

13.  Trimboli P, Ulisse S, D'Alò M, Solari F, Fumarola A, RuggieriM, De Antoni E, Catania A, Sorrenti S, Nardi F, D'ArmientoM. Analysis of clinical, ultrasound and colour flow-Doppler characteristics in predicting malignancy in follicular thyroid neoplasms. ClinEndocrinol 2008;69:342-4.

14.  D'Ajello F, Cirocchi R, Docimo G, Catania A, Ardito G, Rosato L, Avenia N. Thyroidectomy with ultrasonic dissector: a multicentric experience. G Chir 2010;31:289-92.

15.  Johnson S, Goldenberg D. Intraoperative Monitoring of the Recurrent Laryngeal Nerve During Revision Thyroid Surgery. OtolaryngolClin N Am 2008;41:1147-54.

16.  Peix JL, Van Box Som P, Olagne E, Mancini F, Bourdeix O. Résultats des réinterventions pour goitres. Ann Chir 1997;51:217-21.

17.  Calò PG, Pisano G, Piga G, Medas F, Tatti A, Donati M, Nicolosi A. Postoperative hematoma after thyroid surgery. Incidenceand risk factors in our experience. Ann ItalChir 2010;81:343-7.

18.  Chao TC, Jeng LB, Lin JD, Chen MF. Reoperative Thyroid Surgery. World J Surg 1997;21:644-7.

19.  Muller PE, Jakoby R, Heinert G, Spelsberg F. Surgery for Recurrent Goitre: Its Complications and their Risk Factors. Eur JSurg 2001;167:816-21.

20.  Wilson DB, Staren ED, Prinz RA. Thyroid Reoperations: Indications and Risks. Am Surg 1998;64:674-8.

21.  Calò PG, Farris S, Tatti A, Piga G, Malloci A, Nicolosi A. Le urgenze in chirurg-iatiroidea. Nostra esperienza. ChirItal 2006;58:323-9.

22.  Levine KE, Clark AH, Duh QY, Demeure M, SipersteinAE,Clark OH. Reoperative thyroid surgery. Surgery 1992;111:604-9.

23.  Moley JF, Lairmore TC, Doherty GM, Brunt LM, Debenedetti MK. Preservation of the recurrent laryngeal nerves in thyroidand parathyroid reoperations. Surgery 1999;125:673-9.

24.  Pironi D, Panarese A, Candioli S, Manigrasso A, La Gioia G, Romani AM, Arcieri S, Mele R, Filippini A. Reinterventi in chirurgiatiroidea: contrib-utocasistico e revisionedellaletteratura. G Chir 2008;29:407-12.

25.  Conzo G, Circelli L, Pasquali D, Sinisi A, Sabatino L, AccardoG, Renzullo A, Santini L, Salvatore F, Colantuoni V. Lessons tobe learned from the clinical management of a MEN 2A patientbearing a novel 634/640/700 triple mutation of the RET proto-oncogene. ClinEndocrinol 2012; In Press, doi: 10.1111/j.1365-2265.2012.04412.x.

Corresponding Author

Dr S. Zahir Hussain