RESUMEN
BACKGROUND: Laryngeal complications occur in thyroidectomies as a result of several factors, but especially because of nerve damage. We compared intraoperative stimulation neuromonitoring (IONM) with intraoperative continuous electromyographic neuromonitoring (IEM) to evaluate their ability to identify postoperative laryngeal complications. METHODS: This prospective clinical trial included 174 patients (348 nerves) who had both IONM and IEM. We recorded age, sex, pathology, vocal fold motility, and complications. RESULTS: IONM identified 334 nerves, whereas IEM identified 348. Five patients had transient laryngeal complications, 2 bilateral, and 3 unilateral recurrent laryngeal nerve paresis. In addition, in 2 patients IEM showed placement of the tracheal tube balloon on the vocal folds, which led to correction. Sensitivity and specificity were 96.48% and 100% for IONM and 100% and 100% for IEM, respectively. IONM had a positive predictive value of 100% and a negative predictive value of 36.84%. The positive and negative predictive values of IEM were 100%. CONCLUSIONS: Both techniques identify recurrent laryngeal nerve injuries; however, IEM seems to have an advantage concerning the nonsurgical laryngeal complications and may play a role in preventing morbidity.
Asunto(s)
Electromiografía , Monitoreo Intraoperatorio/métodos , Traumatismos del Nervio Laríngeo Recurrente/diagnóstico , Tiroidectomía/efectos adversos , Tiroidectomía/métodos , Adolescente , Adulto , Anciano , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/diagnóstico , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos , Traumatismos del Nervio Laríngeo Recurrente/etiología , Traumatismos del Nervio Laríngeo Recurrente/fisiopatología , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Factores de Riesgo , Sensibilidad y Especificidad , UltrasonidoRESUMEN
BACKGROUND: Hemostasis is important in thyroid surgery to avoid complications. Our aim was to evaluate the effectiveness of the harmonic scalpel in patients undergoing total thyroidectomy. METHODS: In this study, 90 patients were randomized into group A (classic technique of tying and knots) and group B (harmonic scalpel). We recorded the following: age, sex, pathology, thyroid weight, hemostatic technique, duration of operation, change in calcemia (DeltaCa), change in hematocrit (DeltaHt), change in hemoglobin (DeltaHgb), change in white blood cell count (DeltaWBC), vocal motility, operative difficulty, postoperative vocal alteration, postoperative pain, complications, blood in the drains, operating time, mass of gland excised per minute, and hospitalization. RESULTS: Differences (p < .05) were observed concerning duration of surgery, operative difficulty, postoperative pain, hospitalization, DeltaWBC, and quantity of gland removed per minute. No recurrent laryngeal nerve (RLN) palsies were observed. CONCLUSIONS: Use of the Harmonic Scalpel in total thyroidectomy is more effective than the clamp-and-tie technique: the duration of surgery, intraoperative difficulty, postoperative pain, and hospitalization are reduced. Both techniques are equivalent concerning RLN injuries, postoperative vocal alterations, and blood loss.
Asunto(s)
Hemostasis Quirúrgica/métodos , Tiroidectomía/métodos , Adulto , Pérdida de Sangre Quirúrgica/prevención & control , Calcio/sangre , Femenino , Hemostasis Quirúrgica/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Dolor Postoperatorio/prevención & control , Tiroidectomía/instrumentaciónRESUMEN
AIMS: The use of prosthetic material is a well-accepted practice for the treatment of large ventral defects. The aim of this study is to present the effectiveness of two different prosthetic materials for large ventral defects. METHODS: In this retrospective 3-year study, 41 patients (17 males, 24 females) underwent surgical correction of large abdominal wall defects. Two subgroups were formed based on the possibility of peritoneal preservation. In the first group (24 patients) the bifilament polypropylene mesh was used, while in the second group (17 patients) the expanded polytetrafluroethylene patches were used. RESULTS: The mean hospitalisation time was 7.8 days (SD 9.2 days) for the first and 10 days (SD 4.2 days) for the second group (p=ns). Group A presented the following complications: Two seromas, 1 fistula, 2 wound infections. Removal of the mesh was necessary in one case. Two recurrences were noticed during the 5-year follow-up period. Group B presented a seroma and an infection, but no recurrences. As for complications, no statistical difference exists between the two groups. Furthermore, 5 patients (20.83%) from group A complained of abdominal discomfort due to stiffness, especially when they were bending (p=0.029). CONCLUSIONS: Both prosthetic patches are safe and effective when used in the repair of large abdominal wall defects. Operative complications are within acceptable limits, and the reherniation rate is low.