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MINERVA CHIRURGICA

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Minerva Chirurgica 2009 December;64(6):565-71

language: English

Thyroidectomy in patients at high-risk of bleeding: can it be safely performed?

Abboud B. 1, Sleilaty G. 1, Braidy C. 1, Melkane A. 1, Nasr F. 2

1 Department of General Surgery, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University Beirut, Lebanon;
2 Department of Hematology, Hotel Dieu de France Hospital, Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon


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AIM: This study evaluated the safety of thyroid surgery in patients where anticoagulation was unavoidable or in patients with coagulopathy.
METHODS: The records of all patients having high risk of bleeding at the time of thyroidectomy (July 2000 and March 2005) were retrospectively reviewed to evaluate intraoperative and postoperative bleeding.
RESULTS: Ten patients were studied. Thyroid lobectomy with isthmusectomy (N=3) and bilateral thyroidectomy (N=7) were performed. Intraoperative surgical hemostasis was meticulous using ligasure vessel sealing system. Patients were divided in 3 groups. Group I (N=2) had small-vessel vasculitis, underwent thyroidectomy under full heparinization. Heparin therapy was continued until full anticoagulation by oral anticoagulants. Group II (N=2) had a documented congenital coagulation defect, had a pre and postoperative special protocols. Group III (N=6) underwent simultaneous thyroid and cardiac surgery (e.g.: intraoperative full heparinization and postoperative antipla-telet therapy in some cases). No extra-bleeding was noted on surgical reports. In the postoperative period, one patient developed a superficial small hematoma in the neck that resolved spontaneously. Transient unilateral laryngeal nerve palsy and transient hypocalcemia were seen in one and two patients respectively.
CONCLUSIONS: Thyroidectomy in patients with coagulopathy is feasible with low risk of bleeding if meticulous hemostasis, particularly using ligasure vessel sealing system, is respected.

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dbabboud@yahoo.f