IONM contributes to visual and functional identification of the EBSLN and decreases the rate of EBSLN injury during superior pole dissection. Routine use of IONM to identify the EBSLN will minimize the risk of injury during thyroidectomy.
Objectives: This study aimed to analyze the effects of intraoperative neuromonitoring (IONM) on the prevalence of vocal cord palsy (VCP) in thyroid surgery. Methods: Data from 493 patients (839 nerves at risk [NAR]) who underwent thyroid surgery between July 2014 and May 2016 were retrospectively evaluated. The patients were divided into 2 groups: Group 1 (G1) consisted of patients who underwent surgery without IONM, whereas group 2 (G2) consisted of patients who underwent surgery with IONM. The surgical techniques were identical, and experienced surgeons performed the procedures in both groups. Intraoperative neuromonitoring was performed in compliance with the International Neural Monitoring Guidelines. Results: In total, 211 patients (170 female, 41 male) with 360 NAR were included in G1, and 282 patients (220 female, 62 male) with 479 NAR were included in G2. The number of VCP per NAR in G1 and G2 was 33 (9.2%) and 27 (5.6%), respectively ( P = .005). The number of transient VCP per NAR in G1 and G2 was 27 (7.5%) and 23 (4.8%; P = .230), respectively. The number of permanent VCP per NAR in G1 and G2 was 6 (1.7%) and 4 (0.8%; P = .341), respectively. Bilateral VCP was detected in 4 (2.7%) patients in G1, whereas there was no patient with bilateral VCP in G2 ( P = .033). Conclusions: Intraoperative neuromonitoring may decrease the incidence of total VCP and prevent the development of bilateral VCP, which has unfavorable results for both patients and health-care professionals.
Aims and Scope Eurasian Journal of Medicine (Eurasian J Med) is an international, scientific, open access periodical published by independent, unbiased, and tripleblinded peer-review principles. The journal is the official publication of
The external branch of the SLN contributes to the ipsilateral posterior cricoarytenoid muscle innervation in one-third of the cases. This contribution is usually unilateral, but is occasionally bilateral.
Anastomotic leaks can be very dangerous in colorectal cancers. Protective loop ileostomy is life-saving in low anterior rectal tumors to prevent pelvic sepsis. The aim of this study is to compare early morbidities for stapled, handsewn closure (end to end) or handsewn closure (anterior wall only) of loop ileostomy, and to further assess efficacy and safety for each technique. Methods Patients who underwent loop ileostomy closure from January 2014 and December 2019 retrospectively were analyzed. Multivariate logistic regression was used to determine the effect of the potential risk factors on the rate of each complication. The patients were divided into three groups based on the anastomoses. The first group included patients who had handsewn anterior closure; the second group included patients who had side-to-side anastomosis using linear stapler, and the third group included patients who had end-to-end handsewn anastomosis. The primary endpoint of the study was the postoperative 30 days. IBM Statistical Package for the Social Sciences (SPSS), version 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Results A total of 198 patients underwent reversal. There was a statistical difference between the handsewn anterior wall and stapler anastomosis in terms of postoperative ileus and wound infection. The handsewn group was superior to anastomosis with stapler (p: 0.027 and p: 0.042, respectively). A statistical difference was found between handsewn anterior wall closure and handsewn end-to-end anastomosis in terms of postoperative ileus, wound infection, and postoperative hospital stay (p: 0.013, p: 0.037, and p: 0.046, respectively). When stapled anastomosis and handsewn end-to-end anastomosis techniques were compared, a statistical difference was found in terms of postoperative ileus risk (p: 0.043), but no significant difference was found in terms of postoperative wound infection and hospital stay. Conclusions There was no significant difference in the rate of anastomotic leakage between the handsewn and stapled techniques. The rate of small-bowel obstruction was higher in the handsewn group. As a result, in this study, it was revealed that the handsewn anterior wall closure technique is the best among all ileostomy closure techniques.
T iroid cerrahisi en sık uygulanan endokrin cerrahi girişim olup, olguların büyük bölümüne primer cerrahi uygulanmaktadır. Bununla birlikte, bazen daha önce girişim uygulanan tiroid lojuna nüks guatr veya tiroid kanseri nedeni ile ikincil cerrahi girişim gerekebilmektedir. [1] İkincil girişimlerin primer cerrahiye göre nadir olması hem hasta hem de cerrah için şanstır. Hastanın hayat kalitesi üzerine direkt etkisi olan reküren laringeal sinir (RLS) paralizisi ve hipoparatiroidizm gibi spesifik postoperatif komplikasyon riski ikincil cerrahilerden sonra belirgin daha yüksektir. [1-3] Amaç: İkincil tiroid cerrahisi primer cerrahiye göre nadir uygulanmaktadır. Geçirilmiş ameliyata bağlı oluşan skar dokusu ve dokularin artan frajilitesi nedeni ile ikincil cerrahilerde komplikasyon riskinin yüksek olduğu bilinmektedir. İkincil cerrahilerde komplikasyon oranını azaltmak icin birçok cerrahi teknik ve strateji önerilmiştir. Bu çalışmada; lateral yaklaşımla intraoperative sinir monitorizasyonu (IONM) kullanılarak ikincil tiroid cerrahisi uygulanan olgularda komplikasyon oranlarını değerlendirmeyi amaçladık. Yöntem: Daha önce benign ve malign tiroid hastalıkları nedeni bir tiroid cerrahisi geçiren ve ikincil cerrahi girişim uygulanan 44 hastanın verileri (Grup 1), primer cerrahi uygulanan son 44 hastanın verileri (Grup 2) ile karşılaştırıldı. Lobektomi yapıldıktan sonra patolojide malignite saptanan ve müdahale edilmemiş diğer loba tamamlayıcı tiroidektomi uygulanan hastalar çalışma dışı bırakıldı. İkincil cerrahide sternokleidomastoid kas ön kenarı ve strep kasları arasından girilerek lateral yaklaşım uygulandı. Primer cerrahide ise orta hattan tiroid lojuna girildi. Tüm hastalara standart IONM uygulandı. Hipokalsemi klinik semptom olup olmadığına bakılmaksızın, serum kalsiyum düzeyinin ilk 48 saatte 8 mg/dl veya altında bir değer saptanması olarak tanımlandı. Geçici ve kalıcı rekuren laringeal sinir paralizisi risk altındaki sinir sayısına göre değerlendirildi. Loba uygulanan girişim şekli; nuks, Graves hastaliği, substernal guatr, santral diseksiyon uygulanması yüksek riskli girişim olarak tanımlandı. Bulgular: Yaş ortalaması grup 1 ve 2'de sırası ile 49.9+14.1 ve 45+12.6 (22-90) idi (p=0.69). Cinsiyet dağılımı, grup 1 ve 2'de kadın oranı %90.9 (n:40), %75 (n=33) idi (p=0.87). Grup 1 ve 2'de sırası ile 11 (%25) ve 7 hastaya (%15.9) malign hastalık nedeni ile girişim uygulandı (p=0.29). İki taraflı girişim grup 1 ve 2'de sırası ile 26 (%59.1) ve 28 (%63.6) hastaya uygulandı. Geçiçi ve kalıcı hipokalsemi oranları grup 1 ve 2'de sırası ile %34.1 (n=15), %22.5, %2.5 (n=1), %0 olup, fark anlamlı değildi (p=0.237, p=1). Birinci grupta 71 ikinci grupta 72 loba müdahale edildi. Grup 1'deki girişimlerin hepsi (%100), grup 2'dekilerin 23'u (%31.9) yüksek riskli girişim olup, aralarındaki fark anlamlı idi (p<0.0001). Grup 1 ve 2'de sırası ile geçici vokal kord paralizisi oranları %4.2 (n=3), %6.9 (n=5) (p=0.719), kalıcı vokal kord paralizisi oranları ise %2.8 (n=2) ve %0 (p=0.245) idi. Sonuç: İkincil cerrahi girişimler, dikkatli v...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.