Recurrent laryngeal nerve injury and hypoparathyroidism rates in reoperative thyroid surgery

Abstract

Objective: Reoperative thyroid surgery is rare and has a high complication rate. This retrospective cohort study was performed to determine the recurrent laryngeal nerve injury and hypoparathyroidism rates after reoperative thyroid surgery in two university hospitals in Benghazi, Libya.
Material and Methods: All consecutive patients who underwent reoperative thyroid surgery between January 2002 and July 2014 were included retrospectively. The cohort was divided according to whether the reoperation was in the previously operated lobe or both lobes (ipsilateral group), or only in the previously non-operated lobe (contralateral group).
Results: Of the 73 patients, 66 were female and seven were male. The median age was 37 (19-80) years. Nine (12.3%), five (6.8%), and one (1.4%) patient developed postoperative transient hypocalcemia, transient recurrent laryngeal nerve palsy, and permanent recurrent laryngeal nerve injury, respectively. None of the patients developed permanent hypocalcemia. The ipsilateral group had a higher rate of permanent recurrent laryngeal nerve injury after reoperation than the contralateral group (3.1% vs. 0%). It also had higher rates of transient recurrent laryngeal nerve injury (12.5% vs. 2.4%) and transient hypocalcemia (28.1% vs. 0%), but the two groups did not differ in terms of permanent hypocalcemia rates (both 0%).
Conclusion: Reoperative thyroid surgery is technically challenging with a high incidence of complications. The ipsilateral group had more complications after reoperative thyroid surgery than the contralateral group. Hemi- or total thyroidectomy at the primary surgery is recommended to reduce the frequency of reoperative thyroid surgery.

Authors declared that the research was conducted according to the principles of the World Medical Association Declaration of Helsinki “Ethical Principles for Medical Research Involving Human Subjects”, (amended in October 2013).

Informed consent was not received due to the retrospective nature of the study.

Externally peer-reviewed.

Concept - M.B.; Design - M.B., S.T.; Supervision - M.B.; Resource - M.B., S.T., R.A.; Materials - S.T., R.A.; Data Collection and/or Processing - S.T., R.A.; Analysis and/or Interpretation - M.B., S.T.; Literature Search - M.B., S.T., R.A.; Writing Manuscript - M.B., R.A.; Critical Reviews - S.T., M.B., R.A.

No conflict of interest was declared by the authors.

The authors declared that this study has received no financial support.

The authors would like to thank Essam S. Hussein, head of data management at Benghazi Medical Center, for help with statistical analysis.