Measuring neck circumference to predict and detect haemorrhage following thyroid surgery. A case series and literature review

Post-thyroidectomy bleeding is a fortunately rare but potentially life-threatening complication that may increase postoperative morbidity and hospital stay. In this case series, we demonstrate the relation between the measurement of neck circumference and haemorrhage following thyroid surgery and the value of this measurement in predicting post-thyroidectomy haemorrhage.

Currently, there is no simple and reliable method available for the early detection of post-thyroidectomy bleeding. Continuous pressure measurement could be a potential tool for the early detection of haemorrhage but is invasive, and more data are required to recommend threshold values for revision surgery. Early recognition and prompt surgical intervention are key to the management of cervical haematoma. Measurement of the neck circumference is a valuable adjunct tool in the early recognition of post-thyroidectomy bleeding. In this case series, we concluded that a 4-cm increase in neck circumference may trigger the clinical decision for cervical exploration.

Feasibility and Efficacy of Laparoscopic Sleeve Gastrectomy as a Revisional Procedure After Failed Gastric Plication in Morbidly Obese Patients

Background: Failure of adequate weight loss or weight regain has been reported after laparoscopic greater curve plication (LGCP). The primary aim of this retrospective study is to analyze weight loss outcome after revision of failed LGCP into laparoscopic sleeve gastrectomy (LSG). Patients and Methods: Patients who experienced failure (insufficient weight loss/weight regain) after LGCP performed in our center from 2009 to 2012 were included. LSG was performed for all patients. Results: Among 127 who underwent LGCP, 42 patients (33%) underwent revision. Mean body mass index (BMI) at time of LGCP was 44 ± 6 kg/m². The highest % total weight loss (%TWL) after LGCP ranged from 11% to 34% (24.1 ± 5) (corresponding to % excess weight loss [%EWL] of 12%-47% [33.5 ± 12]). The time interval between LGCP and LSG ranged from 12 to 25 months (15.4 ± 3.8). After conversion, 2 patients (5%) experienced acute leakage managed by endoscopic stenting. After LSG, mean BMI (kg/m²) was 38, 32, 30, 28, 29, 30.2, and 30.4, while mean %TWL reached 9%, 19%, 24%, 29%, 25%, 25%, and 24% and mean %EWL reached 15%, 51%, 69%, 77%, 68%, 66%, and 64% at 1 month, 6 months, 1, 2, 3, 4, and 5 years, respectively. Except for results at 1 month, all results showed statistical significance (P ≤ .05). After LSG, the incidence of diabetes mellitus and hypertension dropped from 15 (35%) and 13 (30%) to 2 (5%) and 3 (7%) patients, respectively. No follow-up data (0%) were missed. Conclusion: LSG after failed LGCP has promising weight loss outcomes.

Laparoscopic cholecystectomy in cirrhotics: a prospective randomized study comparing the conventional diathermy and the harmonic scalpel for gallbladder dissection

BACKGROUND

Ultrasonically activated devices have been used for gallbladder dissection in laparoscopic cholecystectomy (LC) with encouraging results. The aim of the present study was to compare the surgical outcome of LC performed by the harmonic shears to that performed by the conventional diathermy in patients with cirrhosis.

METHODS

In this prospective randomized study, 40 cirrhotic Child-Pugh's classes A and B patients with symptomatic uncomplicated gallstones disease were randomly assigned to either the Harmonic scalpel LC group (20 patients) or the conventional diathermy LC group (20 patients).

RESULTS

The use of the harmonic shears was associated with a statistically significant shorter median operative time (55 vs. 82.5 minutes, P = .000), less median estimated intraoperative blood loss (50 vs. 120 mL, P = .000), and lower incidence of gallbladder perforation (10% vs. 70%, P = .000). In the Harmonic scalpel LC group, Laparoscopic subtotal cholecystectomy was resorted to in eight patients (40%) compared with six patients (30%) in the conventional diathermy LC group. No statistically significant difference was found between both groups as regards the conversion rate, the median hospital stay, and the incidence of postoperative complications. Neither bile leaks nor Bile duct injuries were encountered in either group. Similarly, no mortalities were encountered in the present study.

CONCLUSIONS

The Harmonic shears achieved complete hemobiliary stasis. Further, it provided a superior alternative to the conventional diathermy in terms of shorter operative time, less intraoperative blood loss, and lower incidence of gallbladder perforation partly through facilitating the performance of laparoscopic subtotal cholecystectomy.