To ligate or not the inferior thyroid artery to avoid hypocalcaemia after thyroid surgery.

BACKGROUND: Hypocalcaemia is a well recognized complication of thyroid surgery. We have compared the prevalence of hypocalcaemia in our patients following ligation and non-ligation of the inferior thyroid artery (ITA) during thyroid surgery. METHODS: A prospective observational study was done from January 2000 to December 2004, at Fauji Foundation Hospital, Rawalpindi. All patients undergoing subtotal or total thyroidectomy were placed in two groups at random. Group I had ITA ligated whereas in Group II, ITA was not ligated. RESULTS: 310 patients were operated, majority of them being female (97.10%). Transient hypocalcaemia was observed in 4.29% patients in Group I and 3.4% patients in Group II. Permanent hypocalcaemia was observed in 1.84% and 1.36% patients in Group I and Group II, respectively. Results were statistically insignificant (p value > 0.5%). CONCLUSION: There is no significant difference in post-operative hypocalcaemia whether or not the ITA is ligated.

Does sex affect the outcome of laparoscopic cholecystectomy? A retrospective analysis of single center experience.

INTRODUCTION: The aim of our study was to determine the effect of sex on the outcome of laparoscopic cholecystectomy in terms of operative time, conversion to open cholecystectomy, postoperative complications and mean hospital stay. METHODS: In this retrospective observational study, we analyzed the medical records of 2061 patients who underwent laparoscopic cholecystectomy in the surgical department of Khyber Teaching Hospital (Peshawar, Pakistan) between March 2008 and January 2010. χ(2) test and t-test were respectively used to analyze categorical and numerical variables. P ≤ 0.05 was considered significant. RESULTS: The study included 1772 female and 289 male patients. The mean age for male patients was 44.07 ± 11.91 years compared to 41.29 ± 12.18 years for female patients (P = 0.706). Laparoscopic cholecystectomy was successfully completed in 1996 patients. The conversion rate was higher in men (P < 0.001), and the mean operating time was longer in men (P < 0.001). Bile duct injuries occurred more frequently in men (P < 0.001). Gallbladder perforation and gallstone spillage also occurred more commonly in men (P = 0.001); similarly severe inflammation was reported more in male patients (P = 0001). There were no statistically significant differences in mean hospital stay, wound infection and port-site herniation between men and women. Multivariate regression analysis showed that the male sex is an independent risk factor for conversion to open cholecystectomy (odds ratio = 2.65, 95% confidence interval: 1.03-6.94, P = 0.041) and biliary injuries (odds ratio = 0.95, 95% confidence interval: 0.91-0.99, P-value = 0.036). CONCLUSIONS: Laparoscopic cholecystectomy is often challenging in men on account of more adhesions and inflammation. This leads to higher conversion rates and more postoperative complications. Optimized planning and a more experienced operating surgeon may help overcome these problems.