BackgroundThe prevalence of recurrent laryngeal nerve (RLN) injury is higher in repeat than in primary thyroid operations. The use of intraoperative nerve monitoring (IONM) as an aid in dissection of the scar tissue is believed to minimize the risk of nerve injury. The aim of this study was to examine whether the use of IONM in thyroid reoperations can reduce the prevalence of RLN injury.MethodsThis was a retrospective cohort study of patients who underwent thyroid reoperations with IONM versus with RLN visualization, but without IONM. The database of thyroid surgery was searched for eligible patients (treated in the years 1993–2012). The primary outcomes were transient and permanent RLN injury. Laryngoscopy was used to evaluate and follow RLN injury.ResultsThe study group comprised 854 patients (139 men, 715 women) operated for recurrent goiter (n = 576), recurrent hyperthyroidism (n = 36), completion thyroidectomy for cancer (n = 194) or recurrent thyroid cancer (n = 48), including 472 bilateral and 382 unilateral reoperations; 1,326 nerves at risk (NAR). A group of 306 patients (500 NAR) underwent reoperations with IONM and 548 patients (826 NAR) had reoperations with RLN visualization, but without IONM. Transient and permanent RLN injuries were found respectively in 13 (2.6 %) and seven (1.4 %) nerves with IONM versus 52 (6.3 %) and 20 (2.4 %) nerves without IONM (p = 0.003 and p = 0.202, respectively).ConclusionsIONM decreased the incidence of transient RLN paresis in repeat thyroid operations compared with nerve visualization alone. The prevalence of permanent RLN injury tended to be lower in thyroid reoperations with IONM, but statistical validation of the observed differences requires a sample size of 920 NAR per arm.

Mastering the technique of intraoperative RLN neuromonitoring in thyroid surgery requires the surgeon to perform independently approximately 50 monitored procedures, what allows for achieving the predictive value of the method that is comparable to outcomes published by referral centers.

BackgroundThyroid disorders are very common in adults. Despite advances in conservative management, surgery remains a treatment modality of choice in many cases. The mortality and morbidity of thyroidectomy are low, but long-term postoperative hypoparathyroidism (HPT) remains a prominent complication of the procedure.The aim of this study was to assess the incidence of permanent HPT and identify the risk factors for this complication in a cohort of post-thyroidectomy patients followed at a District Endocrine Clinic.Material/MethodsThis was a retrospective analysis of 401 patients followed up at a Regional/District Endocrine Clinic, who had undergone thyroid surgery in the years 1993–2011. The percentage of patients with permanent (>12 months) HPT was the primary endpoint of the study. The statistically analyzed data of patients with permanent HPT versus the remaining patients free from postoperative complications included their demographic data, indications for surgical treatment of their thyroid disorder, and extent of the thyroid resection. The risk factors for postoperative hypoparathyroidism were assessed using logistic regression analysis.ResultsPermanent HPT following surgery on the thyroid gland occurred in 8.5% of the patients. It was more frequent following total thyroidectomy (20.2%) than near-total thyroidectomy (6.7%) or subtotal thyroidectomy (4.2%); p<0.0001. A multivariate statistical regression analysis demonstrated that primary total thyroidectomy was a significant risk factor for permanent HPT (OR 6.5; 95% CI: 2.9–14.4; p<0.0001).ConclusionsTotal thyroidectomy was associated with increased prevalence of permanent hypoparathyroidism when compared to less extensive thyroid resection modes in patients with benign thyroid diseases.

IntroductionAcute appendicitis (AA) is one of the most common reasons for emergency surgery within the abdominal cavity in Poland.AimTo compare outcomes of surgical treatment of AA using both classical (OA) and laparoscopic methods (LA).Material and methodsRetrospective analysis of 299 patients (157 men and 142 women) operated on in 2008–2011 due to AA. The following comparisons between LA and OA were done: mean operative time, mean hospital stay after surgery, conversion rate, proportion of LA to OA in successive years.ResultsLaparoscopic appendectomy was performed in 170 (56.9%) patients (74 men and 96 women), whereas OA was done in 89 (29.8%) patients (44 men and 45 women). In 13.4% of patients (24 men and 16 women) conversion from LA to OA was done. Mean operating time was 53.4 ±16.1 min (range: 25–100 min) for LA, and 55.4 ±20.2 min (range: 20–140 min) for OA; p = 0.64. Mean hospital stay after LA was 4.0 ±1.2 days (range: 2–9 days), while it was 6.0 ±4.2 days (range: 2–28 days) after OA; p < 0.001. Laparoscopic appendectomy was 24.1% of all appendectomies performed in the year 2008, 54.1% in the year 2009, and in consecutive years 71.7% in 2010 and 65.6% in 2011.ConclusionsLaparoscopic appendectomy method did not require longer surgery times and entailed shorter hospital stays as compared with OA. In our opinion, LA should be the preferred approach in surgical treatment of AA in adults.