Veerabhadra Rao Sirigineedi1, Ramarao Kamadi2
BACKGROUND
Thyroid disorders are one of the most common causes of metabolic disturbances with surgery forming the main stay of treatment of thyroid swellings. Thyroid surgery in the hands of experienced surgeons is currently one of the safest procedures performed. While complications following thyroidectomy are rare, their consequences can often be debilitating and even life-threatening when they occur. This prospective study intends to assess the occurrence of various postoperative complications following different thyroidectomy procedures and the role of adequate preoperative patient preparation, careful and meticulous surgical technique and early recognition of postoperative complications with the prompt institution of treatment in reducing morbidity and providing the patient with the best chance of a satisfactory outcome.
MATERIALS AND METHODS
The present clinical study on complications of thyroid surgery has been made over a period of 24 months from August 2014 to August 2016 at Government General Hospital, Kakinada, utilising the cases admitted and treated in the Department of General Surgery. 441 cases were operated during this span of period (n=441), among them 55 complications were observed.
RESULTS
Thyroid surgeries constituted 8.3% of major surgical procedures carried out at our institution. Solitary thyroid nodule constituted most common thyroid disorder in this study forming 54% of cases followed by MNG (29%). Most of the cases were prevalent in the age group of third and fourth decade. The youngest patient of this series was 18 years and oldest was 65 years. Airway problems in postoperative period were found in 2.3% cases. Haematoma, recurrent laryngeal nerve injury and tracheal collapse secondary to the tracheomalacia were the contributory factors. In this study, 3 cases had permanent/bilateral RLN injury, tracheostomy was done. Postoperative hypocalcaemia constituted the most common complication in this study. Permanent hypocalcaemia was seen in 5 cases and were advised lifelong calcium therapy. Postoperative hypothyroidism/thyroid insufficiency occurred in 2.3% cases, which underwent total thyroidectomy. This is the second most common complication. Postoperative wound infection occurred in 1% cases. Haematoma requiring re-exploration of the neck occurred 1.1% cases, which required evacuation. Two cases of tracheal collapse following thyroidectomy were encountered. This complication although uncommon can prove fatal unless treated immediately.
CONCLUSION
Thyroid surgery is safe and can be performed with minimal morbidity and mortality for a wide range of diseases of the gland. Thyroidectomy often offers the best means of permanent cure with properly selected cases. Though mortality has decreased morbidity continues to exist by virtue of anatomical variations of structures. Complications are prone to occur in best of surgical hands, which can be minimised by meticulous attention, identification and preservation of structural details.
