[Technics and complications in reinterventions on the thyroid]

In preference to the two long-established operative procedures for recurrent goitre - extracapsular and intracapsular resection - we have introduced meticulous preparation between the thin capsule around the recurrent goitre and the more solid external capsule in a procedure which combines the advantages of both older methods and avoids most of their pitfalls. The recurrent laryngeal nerves and the parathyroids are always outside the external capsule. The incidence of injury to these structures is minimised by this procedure. From 1980-1985 we performed 2575 thyroid operations, of which 165 operations were for recurrent goitre (6.4%), bilateral in 89 cases. Two patients died of cardiopulmonary complications (1.2%). Preoperative laryngeal nerve palsy was present in 21 cases, postoperative acquired nerve injuries occurred in 28 patients, all in all 31 nerve paralysis (18.8%), or 12.2% when compared with nerves at risk. Eight patients suffered laryngeal nerve palsy on both sides (five with preoperative nerve palsy on one side). Eleven patients showed normal function of laryngeal nerves on follow-up, whilst permanent nerve palsy was found in seventeen cases (10.3%), or 6.7% when related to nerves at risk. Hypoparathyroidism was found in 7 patients of which 4 cases showed permanent changes (2.4%).