Upper respiratory complications of thyroidectomy for large goitres .


Research type: Research Paper

Authors: Abdel Rahim, Adil Awad .

Abstract: Respiratory obstruction is a well known serious and life threatening complication of thyroid surgery particularly in large goitres. The postoperative respiratory complications of patients presenting with large goitres were studied prospectively. On hundred and three paients with large goitres underwent thyroidectomy in Khartoum and Soba teaching Hospitals in a two years duration from January 1994 to January 1996. The incidence of post-operative respiratory complications in our series is found to be high relative to other published reports (23.3 percent) The incidence of R.L.N. injury was higher in patients in whom the nerve was not identified during surgery. The incidence of non-identification of the R.L.N. is higher in our series compared to the literature. This together with the routine non-ligation of the inferior thyroid artery might have contribued to the higher incidence of respiratory complications in our patients. Tracheostomy was done for 13 patients (12.6 percent), with tracheomalacia being the most common indication (5 patients). Six pre-operative predicting factors for developing serious post-operative predicting factors obstruction were studied. These are :- Long duration (more than 5 years), thyroid cancer, preoperative R.L.N. palsy on indirect laryngoscopy, significant tracheal narrowing and/or deviation, retrosternal extension and difficult intubation at operation. Patients were divided into three groups regarding the prediction of tracheostomy (A., B. and C.). Group A. patients with more than four factors and were predicted to require tracheostomy. Group C. patients with less than two factors and were predicted not to require tracheostomy. Our prediction was successful in 9 out of 13 patient who underwent tracheostomy and 88 patients out of the 90 patients who did not have tracheostomy (with a sensitivity of 69.2 percent and specificity of 97.7 percent). We recommend adopting this method of prediction of tracheostomy for patients with large goitres undergoing thyroidectomy. There was no mortality among patients who underwent tracheostomy .