What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review
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REVIEW
Open Access
What is the treatment of tracheal lesions associated with traditional thyroidectomy? Case report and systematic review Nicola Tartaglia, Roberta Iadarola* , Alessandra Di Lascia, Pasquale Cianci, Alberto Fersini and Antonio Ambrosi
Abstract Aim: The aim of this study is to review the literature focusing on various treatments based on time of tracheal injury and on different surgeons’ personal experience. Methods: We retrospectively reviewed all cases of total thyroidectomy performed at the University Surgical Department of Ospedali Riuniti of Foggia from 2006 to 2017. Only a single case of tracheal lesion due to traditional total thyroidectomy was found. An extensive search of the relevant literature was carried out using MEDLINE (PubMed). We included articles that reported article type, patient number, sex, age, reasons for surgery, time of tracheal perforation intraoperatively or delayed rupture, symptoms, diagnosis, type of surgical procedure, pathological report and follow-up. Results: A total of 156 published studies were screened from the sources listed. Of these, 15 studies were included in the present study. We introduced our case in the analysis. A total of 16 patients were totally analysed. There were seven males (43.7%) and seven females (43.7%), and for two patients, gender was not available. The mean patient age was 41.6 years. Conclusions: The literature review showed very few cases treated differently. However, it would be good to standardise treatments. Tracheal perforation, if encountered, needs to be managed appropriately in centres of expertise with a high volume of thyroidectomies. Keywords: Total thyroidectomy, Tracheal injury, Tracheal surgery, Tracheal lesion, Tracheal laceration, Tracheostomy
Background Thyroidectomy is one of the most common surgical operations performed in endocrine surgery for benign and malignant thyroid disease. Complication rates from total thyroidectomy are low. At present, mortality for this procedure is approximately 0%, and the overall complication rate is less than 3% [1]. These most commonly include vocal fold paresis or paralysis, hypoparathyroidism, hypocalcaemia, haematoma and wound infection [1, 2]. Tracheal injury associated with thyroidectomy is rare (less than 1%) [3]. The trachea may be perforated or lacerated intraoperatively, often recognised and repaired immediately with little patient morbidity. However, unrecognised injury or delayed rupture secondary to tracheal necrosis * Correspondence: [email protected] Department of Surgery, University of Foggia, Luigi Pinto Street, No. 1, 71122 Foggia, Italy
can present up to 2 weeks postoperatively [2]. Because this complication occurs in less than one patient for most thyroid surgeons, it is unlikely that any individual will gather sufficient data to report the management in a series [3]. There are no published reports describing the management of inadvertent tracheal perforation during thyroid surgery [3]. Nevertheless, tracheal perforation, if encountered, needs to be managed
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