No abstract

The prevalence of parathyroid failure syndromes after total thyroidectomy was similar whether a parathyroid gland was inadvertently excised or autotransplanted. Autotransplantation did not influence the permanent hypoparathyroidism rate.

Permanent hypoparathyroidism should not be diagnosed in patients requiring replacement therapy for more than six months, especially if the four parathyroid glands were preserved.

Background: Staged total thyroidectomy has been advised to prevent bilateral recurrent laryngeal nerve paralysis when loss of the signal from neural monitoring is observed after dissection of the initial thyroid lobe. This is supported by expert opinion but hard evidence is lacking. A lost signal can return during surgery or, even if it persists, its positive predictive value is only in the range 60-70 per cent. The aim of the present study was to investigate the clinical outcome of patients in whom total thyroidectomy was performed following loss of signal after dissection of the first thyroid lobe. Methods:This was a prospective observational study of adult patients scheduled for neural monitoring during total thyroidectomy. The prevalence of first-side absence or loss of signal was recorded. The contralateral thyroid lobe was approached routinely. The vagus and recurrent laryngeal nerves on the first side were retested during and at the end of the contralateral procedure.Results: Some 462 patients were included. Loss (32 patients) or initial absence (8) of signal at dissection of the first thyroid lobe was noted in 40 patients (8⋅7 per cent). Total thyroidectomy was completed in 29 patients, and a change of surgical strategy adopted in 11 patients with benign disease. At retesting, 15 of 37 initially silent nerves recovered electromyographic signal after a mean(s.d.) interval of 30(14) min. Postoperative vocal cord palsy/paresis was demonstrated in 24 of 40 patients. One patient developed a bilateral paresis that could be managed conservatively. Conclusion:After an absence or loss of signal of the recurrent laryngeal nerve following dissection of the first thyroid lobe, contralateral thyroidectomy can be performed safely, avoiding the expense, psychological burden and potential complications of a second procedure.

Background Currently, both the American Thyroid Association and the European Thyroid Association recommend preoperative preparation with Lugol's Solution (LS) for patients undergoing thyroidectomy for Graves’ Disease (GD), but their recommendations are based on low-quality evidence. The LIGRADIS trial aims to provide evidence either to support or refute the systematic use of LS in euthyroid patients undergoing thyroidectomy for GD. Methods A multicenter randomized controlled trial will be performed. Patients ≥18 years of age, diagnosed with GD, treated with antithyroid drugs, euthyroid and proposed for total thyroidectomy will be eligible for inclusion. Exclusion criteria will be prior thyroid or parathyroid surgery, hyperparathyroidism that requires associated parathyroidectomy, thyroid cancer that requires adding a lymph node dissection, iodine allergy, consumption of lithium or amiodarone, medically unfit patients (ASA-IV), breastfeeding women, preoperative vocal cord palsy and planned endoscopic, video-assisted or remote access surgery. Between January 2020 and January 2022, 270 patients will be randomized for either receiving or not preoperative preparation with LS. Researchers will be blinded to treatment assignment. The primary outcome will be the rate of postoperative complications: hypoparathyroidism, recurrent laryngeal nerve injury, hematoma, surgical site infection or death. Secondary outcomes will be intraoperative events (Thyroidectomy Difficulty Scale score, blood loss, recurrent laryngeal nerve neuromonitoring signal loss), operative time, postoperative length of stay, hospital readmissions, permanent complications and adverse events associated to LS. Conclusions There is no conclusive evidence supporting the benefits of preoperative treatment with LS in this setting. This trial aims to provide new insights into future Clinical Practice Guidelines recommendations. Trial registration ClinicalTrials.gov identifier: NCT03980132.

Conflicto de intereses: Los autores declaran no tener conflicto de intereses. RESUMENObjetivo: Revisar la literatura actual sobre el uso de la toxina botulínica tipo A (TBA) como complemento en la preparación preoperatoria de la cirugía de pared abdominal compleja. Material y métodos:Se realiza una búsqueda en las bases de datos electrónicas PubMed y Cochrane Library sobre el uso de la TBA. Tras una La mayoría de trabajos no describen apenas complicaciones con su uso, salvo distensión abdominal, tos o dolores de espalda, todas ellas de intensidad leve y limitadas en el tiempo, controlables con el uso de una faja abdominal y en general bien toleradas por los pacientes.Conclusiones: El uso de la TBA es cada vez más frecuente en la cirugía de pared abdominal, aunque los regímenes para su aplicación y dosis siguen sin estandarizarse. Existe una gran heterogeneidad entre los estudios. No obstante, en la mayoría de trabajos se demuestra que, tras la infiltración con TBA, los músculos de la pared abdominal lateral se elongan y se adelgazan, lo que disminuye el diámetro transversal del defecto.Gracias a este efecto se consigue el cierre fascial en la mayoría de los pacientes, beneficio en el control del dolor posoperatorio y no se han observado efectos adversos graves asociados a su uso.Palabras clave: Toxina botulínica A, reconstrucción de la pared abdominal, hernia con pérdida de derecho a domicilio, separación de componentes química, hernia incisonal, neumoperitoneo preoperatorio progresivo.