Comparison between ligasure vs. clamp-and-tie technique in total thyroidectomy for benign multilnodular goiter. A prospective randomized study

Introduction: LigcaSure [Valley Lab, CO, USA] is a bipolar diathermy system that seals vessels with reduced thermal spread. The device has been used successfully in abdominal surgery and has been introduced as a new method for haemostasis during thyroidectomy. This study compares the efficacy and advantages of LigaSure, when used for thyroidectomy in benign nodular thyroid disease, with the conventional clamp-and-tie technique

Methods: 60 patients underwent total thyroidectomy [30 with the conventional clamp-and-tie technique and 30 with LigaSure]. The main outcomes measured were age, sex, operating time, postoperative hypocalcaemia, recurrent laryngeal and nerve palsy, statistical analysis consisted of the chi-squared test and Student's t-test

Results: The mean operating time was significantly shorter in the LigaSure group [115.00 +/- 13.20 vs 88.83 +/- 11. 50 minutes; P=0.00]. Bleeding during surgery was significantly lower in the LigaSure group [118 +/- 15.33 ml vs. 69. 17:11:15 ml P=0.0]. There were no significant differences between the study groups in terms of postoperative hypo-parathyroidism or recurrent laryngeal nerve palsy

Conclusion: The LigciSure vessel sealer is a safe, effective alternative for thyroid surgery that reduces the overall operating time and operative blood loss, however, its higher cost is a significant limiting factor for its use in surgery

Outcome of parathyroidectomy for primary hyperparathyroidism in Sohag university hospital in 5 years: retrospective study

Primary hyperparathyroidism [PHPT] is a common endocrine disease treated very effectively by surgery. It is the commonest cause of hypercalcaemia. The majority of cases are caused by adenoma [80% to 85%], whereas approximately 15% have diffuse hyperplasia of all four parathyroidglands. Rarely [1%], parathyroid carcinoma is the cause of hyperparathyroidism. Parathyroid diseases has not been investigated in our community before. This study had been conducted to analyze the outcome of surgical treatment of [PHPT], as regard the success rate, complications and recurrence. Between May 1999 and July 2004, 14 consecutive patients with [PHPT], who had been submitted to surgery in Sohag University Hospital were enrolled in this study. Analysis of clinical presentations, laboratory and imaging studies, surgical approach, intraoperative findings, and outcome assessment m terms of success rate, complications had been done. A total number of 14 patients diagnosed as PHPT, 10 were women and 4 were men. Their age ranged from 25-51 years, with a mean age of 41.2 +/- 6.9 years. Bone affection was the dominant presenting feature [79%]. All cases showed high level of serum calcium [mean 3.13 +/- 0.42 mmol/L] and parathormone hormone [mean 787.4 +/- 256.6 pg/mL]. Accuracy of ultratsound scanning of the neck was 71% in localization of parathyroid lesions, while that of CT and Sestamibi scan were 85% and 87.5% respectively. A single parathyroid adenoma was the commonest lesion [86%]. All patients, but two, had been followed up from 6 months to 18 months with a mean of 11 +/- 4 months. The success rate was achieved in all but one [92.9%], who had been found to be an ectopic parathyroid adenoma in the superior mediastinum. There was one case who died due to the morbid general medical condition. Postoperative temporary hypocalcaemia was observed in two cases. No permanent injury to RLN was reported in our cases. Parathyroid disease is not uncommon problem in our locality. Surgery of PHPT is a very successful operation with minimal morbidity. Early discovery of PHPT gives the best chance of cure and avoid disastrous complications of this disease

Transition from open to laparoscopic nissen fundoplication

We reviewed Nissen Fundoplication performed from January 2000 to January 2005, encompassing our transition from open to laparoscopic procedures. Records of 33 consecutive patients were reviewed. From year 2000 to 2005, all patients whom suffering from gastro esophageal reflux disease [GERD] and were in need for surgical interference were classified into two groups. First group operated upon by open fundoplication [n= 20]. Second group operated upon laparoscopically [n=13]. Mean operating time for laparoscopic cases was 143 +/- 20 minutes compared with 90 +/- 20 minutes for open cases [P<0.05]. Intraoperative complication rate was similar in both laparoscopic and open group [15%]. Length of hospitalization was shorter for patients who underwent laparoscopic surgery [2.2 days versus 7.2 for open procedures, P <0.05]. In follow-up, 80% of the laparoscopic group was asymptomatic compared with 70% of the open group. In patients who had the open procedure, 15% had wound complications. None of those treated laparoscopically had any complications at trocar insertion sites. Laparoscopic Nissen Fundoplication nowadys is the preferred approach and becomes the first surgical option in treating patients with GERD. It is effective as open fundoplication, safe, associated with a short hospital stay and early return to normal daily life activity