[Rate of complications with systematic exposure of the recurrent laryngeal nerve and parathyroid glands in operations for benign thyroid gland diseases]

The influence of the operation technique on the complication rate of thyroid operations is still a subject of discussions. In this study, we analysed therefore the most important complications, i.e. palsy of the recurrent laryngeal nerve and hypoparathyroidism, specially under the aspect of routine exposition of the recurrent laryngeal nerve and parathyroids.116 patients with goiter operations of the year 1995 (12 different surgeons) were analysed. Age of patients was between 7 and 72 years, mean age 45 years. The operations performed were 70 subtotal resections (benign goiter), 33 near-total-resections (diffuse autonomy or Graves' disease), 33 hemithyroidectomies (scintigraphically "cold" nodules), 4 adenoma resections with combinations of these resections in 24 cases.4.3% of the patients (5/116 patients) developed an unilateral recurrent nerve palsy immediately after operation. Persisting recurrent nerve palsy occurred only in 1.7% (2/116) of these cases. Postoperative nerve palsy was mainly found after extensive resections (2/33 near-total-resections) or operations of recurrent goiter (2/6 re-operations), rarely after routine operations (1/70 subtotal resections). Hypocalcemia was found in 9.5% of the patients (11/116), of which 9 cases were asymptomatic (7.8%) and 2 symptomatic by tetany (1.7%). Persisting hypocalcemia for longer than one week was found in 3.5% (4/116), permanent hypoparathyroidism in 1.7% (2/116) of the patients.Routine systematic exposure of recurrent laryngeal nerves and parathyroids reduces the incidence of complications in thyroid surgery to a minimum. The risk of recurrent nerve palsy increases with extent and difficulty of the operation, with the highest risk for nerve lesions seen in re-operations and near-total-resections.