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Introduction: In recent years, Posterior Component Separation (PCS) with the Madrid modification (Madrid PCS) has emerged as a surgical technique. This modification is believed to enhance the dissection of anatomical structures, offering several advantages. The study aims to present a detailed description of this surgical technique and to analyse the outcomes in a large cohort of patients. Materials and Methods: This study included all patients who underwent the repair of midline incisional hernias, with or without other abdominal wall defects. Data from patients at three different centres specialising in abdominal wall reconstruction was analysed. All patients underwent the Madrid PCS, and several variables, such as demographics, perioperative details, postoperative complications, and recurrences, were assessed. Results: Between January 2015 and June 2023, a total of 223 patients underwent the Madrid PCS. The mean age was 63.4 years, with a mean BMI of 33.3 kg/m2 (range 23-40). According to the EHS classification, 139 patients had a midline incisional hernia, and 84 had a midline incisional hernia with a concomitant lateral incisional hernia. According to the Ventral Hernia Working Group (VHWG) classification, 177 (79.4%) patients had grade 2 and 3 hernias. In total, 201 patients (90.1%) were ASA II and III. The Carolinas Equation for Determining Associated Risks (CeDAR) was calculated preoperatively, resulting in 150 (67.3%) patients with a score between 30% and 60%. A total of 105 patients (48.4%) had previously undergone abdominal wall repair surgery. There were 93 (41.7%) surgical site occurrences (SSO), 36 (16.1%) surgical site infections (SSI), including 23 (10.3%) superficial and 7 (3.1%) deep infections, and 6 (2.7%) organ/space infections. Four (1.9%) recurrences were assessed by CT scan with an average follow-up of 23.9 months (range 6-74). Conclusion: The Madrid PCS appears to be safe and effective, yielding excellent long-term results despite the complexity of abdominal wall defects. A profound understanding of the anatomy is crucial for optimal outcomes. The Madrid modification contributes to facilitating a complete retromuscular preperitoneal repair without incision of the transversus abdominis. The extensive abdominal wall retromuscular dissection obtained enables the placement of very large meshes with minimal fixation.
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The treatment of complex midline hernias remains a particular challenge. The currently refined knowledge of the anatomy in the cadaver laboratory and advancing clinical experience have changed our present approach. The aim of this review is to present a description of the updated surgical procedures and outcomes. We favor the retromuscular or preperitoneal layer for mesh implantation, including the Rives-Stoppa procedure (sublay mesh) and posterior component separation with the Madrid modification. We operated on 334 complex midline incisional hernias: 6.3% retromuscular preperitoneal, 15% after Rives-Stoppa, 2.4% anterior component separation and 76% posterior component separation. A bridging procedure was used in 31%. A complication occurred in 35.3%, most of which were wound healing disorders (SSO). The average length of hospital stay was 7.2 days. We recorded a very low incidence of long-term complications: 3.3% recurrence, 0.9% chronic pain (daily use of pain medication), 6% bulging, 1.8% chronic seroma and 2.6% chronic mesh infection. Despite the associated morbidity, retromuscular/preperitoneal treatment offers excellent long-term results.
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Pared Abdominal , Hernia Ventral , Hernia Incisional , Humanos , Hernia Incisional/cirugía , Hernia Incisional/complicaciones , Pared Abdominal/cirugía , Hernia Ventral/cirugía , Hernia Ventral/etiología , Músculos Abdominales , Mallas Quirúrgicas/efectos adversosRESUMEN
Abdominal wall hernias are common entities that represent important issues. Retromuscular repair and component separation for complex abdominal wall defects are considered useful treatments according to both short and long-term outcomes. However, failure of surgical techniques may occur. The aim of this study is to analyze results of surgical treatment for hernia recurrence after prior retromuscular or posterior components separation. We have retrospectively reviewed patient charts from a prospectively maintained database. This study was conducted in three different hospitals of the Madrid region with surgical units dedicated to abdominal wall reconstruction. We have included in the database 520 patients between December 2014 and December 2021. Fifty-one patients complied with the criteria to be included in this study. We should consider offering surgical treatment for hernia recurrence after retromuscular repair or posterior components separation. However, the results might be associated to increased peri-operative complications.
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Músculos Abdominales , Hernia Ventral , Humanos , Músculos Abdominales/cirugía , Hernia Ventral/cirugía , Estudios de Cohortes , Estudios Retrospectivos , Herniorrafia/métodos , Mallas Quirúrgicas , RecurrenciaRESUMEN
Incisions performed for hepato-pancreatic-biliary (HPB) surgery are diverse, and can be a challenge both to perform correctly as well as to be properly closed. The anatomy of the region overlaps muscular layers and has a rich vascular and nervous supply. These structures are fundamental for the correct functionality of the abdominal wall. When performing certain types of incisions, damage to the muscular or neurovascular component of the abdominal wall, as well as an inadequate closure technique may influence in the development of long-term complications as incisional hernias (IH) or bulging. Considering that both may impair quality of life and that are complex to repair, prevention becomes essential during these procedures. With the currently available evidence, there is no clear recommendation on which is the better incision or what is the best method of closure. Despite the lack of sufficient data, the following review aims to correlate the anatomical knowledge learned from posterior component separation with the incisions performed in hepato-pancreatic-biliary (HPB) surgery and their consequences on incisional hernia formation. Overall, there is data that suggests some key points to perform these incisions: avoid vertical components and very lateral extensions, subcostal should be incised at least 2 cm from costal margin, multilayered suturing using small bites technique and consider the use of a prophylactic mesh in high-risk patients. Nevertheless, the lack of evidence prevents from the possibility of making any strong recommendations.
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BACKGROUND: The best approach for lateral incisional hernia is not known. Posterior component separation (reverse TAR) offers the possibility of using the retromuscular space for medial extension of the challenging preperitoneal plane. The aim of our multicenter study was to compare the operative and patient-reported outcomes measures (PROMs) using two open surgical techniques from the lateral approach: a totally preperitoneal vs a reverse TAR. METHODS: A retrospective cohort study was performed since 2012 to 2020. Patients with lateral incisional hernia treated through a lateral approach were identified from a prospectively maintained multicenter database. Reverse TAR was added when the preperitoneal plane could not be safely dissected. The results obtained using these two lateral approaches were compared, including short- and long-term complications, as well as PROMs, using the specific tool EuraHSQoL. RESULTS: A total of 61 patients were identified. Reverse TAR was performed in 33 patients and lateral retromuscular preperitoneal approach in 28 patients. Both groups were comparable in terms of sociodemographic and comorbidities variables. Surgical site occurrences occurred in 13 cases (21.3%), with 8 patients (13.1%) requiring procedural intervention. During a median follow-up of 34 months, no incisional hernia recurrence was registered. There was a case (1.6%) of symptomatic bulging that required reoperation. Also 12 patients (19.7%) presented an asymptomatic bulging. No statistically significant difference was identified in the complications and PROMs between the two procedures. CONCLUSION: The open lateral retromuscular reconstruction using very large meshes that reach the midline has excellent long-term results with acceptable postoperative complications, including PROMs. A reverse TAR may be added, when necessary, without increasing complications and obtaining similar long-term results.
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Hernia Ventral , Hernia Incisional , Humanos , Hernia Ventral/cirugía , Hernia Ventral/etiología , Estudios Retrospectivos , Músculos Abdominales/cirugía , Herniorrafia/efectos adversos , Herniorrafia/métodos , Mallas Quirúrgicas , Hernia Incisional/cirugía , Hernia Incisional/etiología , RecurrenciaRESUMEN
AIM: This study aimed to describe the results of complex parastomal hernia repair after posterior component separation and keyhole reconstruction. METHOD: We conducted a retrospective review of a prospectively sustained database in one single complex abdominal wall referral centre. We analysed the data of patients who underwent the posterior component separation technique using modified transversus abdominis release for complex parastomal hernia and retromuscular keyhole mesh repair from February 2014 to January 2017. Demographic data, hernia characteristics, operative details and outcomes were analysed. The primary outcome measured was the recurrence rate during the follow-up. RESULTS: Twenty patients were included in this study. Among the patients who underwent surgery for parastomal hernia, 17 patients had a colostomy (85%) and three patients had a ureteroileostomy after the Bricker procedure (15%). The mean body mass index was 33.2 kg/m2 (range 25-47). Twelve patients had an expected associated risk according to the Carolinas equation for determining associated risk classification of >60%. Sixty per cent of our patients had contaminated or dirty/infected wounds. The overall complication rate was 60%. Surgical site infection was observed in 25% of the cases. The mortality rate in our study group was 5% (n = 1). We found clinical or radiological evidence of parastomal hernia recurrence in nine out of 20 (45%) patients during follow-up. No hernia recurrence was detected in the concomitant incisional hernias. CONCLUSIONS: Although posterior component separation in the form of modified transversus abdominis muscle release allows abdominal wall reconstruction, keyhole mesh configuration at the stoma site does not offer satisfactory results in terms of long-term recurrence rate at the parastomal defect.
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Hernia Ventral , Hernia Incisional , Músculos Abdominales/cirugía , Hernia Ventral/etiología , Hernia Ventral/cirugía , Herniorrafia/efectos adversos , Humanos , Hernia Incisional/etiología , Hernia Incisional/cirugía , Recurrencia , Estudios Retrospectivos , Mallas Quirúrgicas , Resultado del TratamientoRESUMEN
BACKGROUND: Management of subcostal incisional hernias is particularly complicated due to their proximity to the costochondral limits in addition to the lack of aponeurosis on the lateral side of the abdomen. We present our results of posterior component separation through the same previous incision as a safe and reproducible technique for these complex cases. METHODS: We present a multicenter and prospective cohort of patients diagnosed with bilateral subcostal incisional hernias on either clinical examination or imaging based on computed tomography from 2014 to 2020. The aim of this investigation was to assess the outcomes of abdominal wall reconstruction for subcostal incisional hernias through a new approach. The outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS: A total of 46 patients were identified. All patients underwent posterior component separation. Surgical site occurrences occurred in 10 patients (22%), with only 7 patients (15%) requiring procedural intervention. During a mean follow-up of 18 (range, 6-62), 1 (2%) case of clinical recurrence was registered. In addition, there were 8 (17%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) of the postoperative compared with the preoperative scores. CONCLUSION: Posterior component separation technique for the repair of subcostal incisional hernias through the same incision is a safe procedure that avoids injury to the linea alba. It is associated with acceptable morbidity, low recurrence rate, and improvement in patients' reported outcomes.
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Músculos Abdominales/cirugía , Abdominoplastia/métodos , Hernia Ventral/cirugía , Herniorrafia/métodos , Hernia Incisional/cirugía , Mallas Quirúrgicas , Femenino , Hernia Ventral/diagnóstico , Hernia Ventral/etiología , Humanos , Hernia Incisional/complicaciones , Hernia Incisional/diagnóstico , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Recurrencia , Reoperación , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The best treatment for the combined defects of midline and lateral incisional hernia is not known. The aim of our multicenter study was to evaluate the operative and patient-reported outcomes using a modified posterior component separation in patients who present with the combination of midline and lateral incisional hernia. METHODS: We identified patients from a prospective, multicenter database who underwent operative repairs of a midline and lateral incisional hernia at 4 centers with minimum 2-year follow-up. Hernias were divided into a main hernia based on the larger size and associated abdominal wall hernias. Outcomes reported were short- and long-term complications, including recurrence, pain, and bulging. Quality of life was assessed with the European Registry for Abdominal Wall Hernias Quality of Life score. RESULTS: Fifty-eight patients were identified. Almost 70% of patients presented with a midline defect as the main incisional hernia. The operative technique was a transversus abdominis release in 26 patients (45%), a modification of transversus abdominis release 27 (47%), a reverse transversus abdominis release in 3 (5%), and a primary, lateral retromuscular preperitoneal approach in 2 (3%). Surgical site occurrences occurred in 22 patients (38%), with only 8 patients (14%) requiring procedural intervention. During a mean follow-up of 30.1 ± 14.4 months, 2 (3%) cases of recurrence were diagnosed and required reoperation. There were also 4 (7%) patients with asymptomatic but visible bulging. The European Registry for Abdominal Wall Hernias Quality of Life score showed a statistically significant decrease in the 3 domains (pain, restriction, and cosmetic) in the postoperative score compared with the preoperative score. CONCLUSION: The different techniques of posterior component separation in the treatment of combined midline and lateral incisional hernia show acceptable results, despite the associated high complexity. Patient-reported outcomes after measurement of the European Registry for Abdominal Wall Hernias Quality of Life score demonstrated a clinically important improvement in quality of life and pain.
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Pared Abdominal/cirugía , Abdominoplastia/métodos , Hernia Ventral/cirugía , Herniorrafia/métodos , Hernia Incisional/cirugía , Dolor Postoperatorio/epidemiología , Abdominoplastia/efectos adversos , Anciano , Femenino , Estudios de Seguimiento , Hernia Ventral/diagnóstico , Herniorrafia/efectos adversos , Humanos , Hernia Incisional/diagnóstico , Masculino , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Medición de Resultados Informados por el Paciente , Estudios Prospectivos , Calidad de Vida , Recurrencia , Reoperación/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
Objective: The aim of this study is to describe the macroscopic features and histologic details observed after retromuscular abdominal wall reconstruction with the combination of an absorbable mesh and a permanent mesh. Methods: We have considered all patients that underwent abdominal wall reconstruction (AWR) with the combination of two meshes that required to be reoperated for any reason. Data was extracted from a prospective multicenter study from 2012 to 2019. Macroscopic evaluation of parietal adhesions and histological analysis were carried out in this group of patients. Results: Among 466 patients with AWR, we identified 26 patients that underwent a reoperation after abdominal wall reconstruction using absorbable and permanent mesh. In eight patients, the reoperation was related to abdominal wall issues: four patients were reoperated due to recurrence, three patients required an operation for chronic mesh infection and one patient for symptomatic bulging. A miscellanea of pathologies was the cause for reoperation in 18 patients. During the second surgical procedures made after a minimum of 3 months follow-up, a fibrous tissue between the permanent mesh covering and protecting the peritoneum was identified. This fibrous tissue facilitated blunt dissection between the permanent material and the peritoneum. Samples of this tissue were obtained for histological examination. No case of severe adhesions to the abdominal wall was seen. In four cases, the reoperation could be carried out laparoscopically with minimal adhesions from the previous procedure. Conclusions: The reoperations performed after the combination of absorbable and permanent meshes have shown that the absorbable mesh acts as a protective barrier and is replaced by a fibrous layer rich in collagen. In the cases requiring new hernia repair, the layer between peritoneum and permanent mesh could be dissected without special difficulty. Few intraperitoneal adhesions to the abdominal wall were observed, mainly filmy, easy to detach, facilitating reoperations.
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Adenocarcinoma/diagnóstico por imagen , Canal Anal/patología , Recurrencia Local de Neoplasia/diagnóstico por imagen , Neoplasias del Recto/diagnóstico por imagen , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Canal Anal/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/cirugía , Estadificación de Neoplasias , Periodo Preoperatorio , Proctectomía , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
El agujero rasgado posterior es una zona clave en la terapia craneal osteopática, pues su tratamiento permite actuar sobre el importante paquete vasculonervioso que lo atraviesa. Las técnicas estructurales de articulación se utilizan para estimular el tejido sutural y devolver la correcta función a las fibras óseas e intersuturales afectadas. El objetivo de la técnica con arcos botantes para la occipitomastoidea es estimular los mecanorreceptores del tejido intersutural, influyendo sobre el contenido del agujero rasgado posterior. Son indispensables una buena evaluación diagnóstica, el conocimiento de los beneficios y riesgos y una correcta ejecución, para normalizar los tejidos de dicha zona, consiguiendo de este modo, mejorar la sintomatología
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Humanos , Osteopatía/métodos , Suturas Craneales , Hueso Occipital , Apófisis MastoidesRESUMEN
INTRODUCCIÓN: La cervicalgia es un transtorno muscoloesquelético muy frecuente en las consultas de Osteopeatía, afectando al 45-54% de la población a lo largo de su vida. Se define como un dolor localizado entre occipucio y la tercera vértebra dorsal. La mayoría de pacientes con cervicalgia no solucionan completamente sus síntomas y su discapacidad, evolucionando con periodos de remisión y exarcerbación. El músculo trapecio es un importante estabilizador escapular e interviene mediante contracción mantenida en la posición de la cabeza. La neuropatía del nervio espinalpodría degenerar la fibra muscular (atrofia o fibrosis) presentando el trapecio las bandas tensas típicas del dolor miosfacial cervical. OBJETIVO: Exponer la relación existente entre la cervicalgia mecánica, el trapecio superior y su inervación a través del nervio espinal (XI). MATERIAL Y MÉTODOS: Se ha realizado una revisión bibliográfica y posterior comentario de una serie de artículos que relacionan la neuropatía del XI par craneal y consecuente afectación del trapecio, en los pacientes con disfunciones miosfaciales cervicales. RESULTADOS: Existe cierta evidencia científica que relaciona las disfunciones del nervio espinal y sus repercusiones en el trapecio superior en los individuos con dolor cervical. CONCLUSIONES: El osteópata debe realizar una correcta evaluación del agujero rasgado posterior y su contenido vasculonervioso para tratar y prevenir las implicaciones del trapecio superior en las cervicalgias
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Humanos , Nervios Espinales/fisiopatología , Dolor de Cuello/fisiopatología , Hueso Trapecio/fisiopatología , Plexo Cervical/fisiopatología , Estudios de Casos y Controles , Medicina Osteopática/tendenciasRESUMEN
Introducción: El pie zambo, es una de las malformaciones musculoesqueléticas más frecuentes en la edad infantil. A pesar de los buenos resultados en la corrección biomecánica del pié mediante el método Ponseti, las pequeñas alteraciones musculares no son infrecuentes, interfiriendo en la progresión e incluso en la corrección del pie. La terapia manual osteopática y la fisioterapia son necesarias en el seguimiento de este tipo de pacientes para optimizar los tratamientos. Objetivo: Exponer la relación existente entre el pie zambo y las alteraciones de la pisada en niños, y por tanto la interferencia del captor postural del pie en el desarrollo postural del niño. Material y Métodos: Se ha realizado una revisión bibliográfica comentada de una serie de artículos que relacionan las alteraciones estructurales de los pies equinovaros congénitos, con las alteraciones del desarrollo muscular del pie y de la pierna, así como las diferencias cuantitativas de la baropodometría en niños tratados por pie zambo con el método Ponseti. Resultados: Estudio de revisión sistemática, retrospectivo, con una muestra de análisis bibliográfico integrado por 15 artículos (n=15), que cumplieron criterios de selección en dos fases de análisis, lo cual supone un 2419 % de los artículos que cumplieron los criterios de selección (n= 62) (inclusión y exclusión), y el 402 % del total de artículos encontrados (n= 373). Conclusiones: El estudio de la pisada del niño en las diferentes fases del tratamiento del pie zambo, y la intervención temprana para la optimización del desarrollo del sistema muscular, de los apoyos plantares y de la distribución de cargas, podría aportar no sólo un elemento de mejora a nivel local, sino del desarrollo postural global del niño
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Humanos , Niño , Anomalías Musculoesqueléticas/terapia , Manipulaciones Musculoesqueléticas/métodos , Pie Zambo/terapia , Equilibrio Postural , Debilidad Muscular/complicaciones , Debilidad Muscular/terapia , Análisis de DatosRESUMEN
Introducción: El pie zambo, o Pie Equino Varo Aducto Congénito, es una de las malformaciones musculoesqueléticas más comunes. Los componentes de la deformidad son el equinismo, varismo, supinación del retropié, y aducción del antepié, existiendo una alteración de la morfología de las articulaciones del tarso, debida a las deformidades óseas. Objetivo: Comprobar las alteraciones en los apoyos plantares de los niños afectos de pie zambo, mediante el análisis estabilométrico y baropodométrico. Estudiar las modificaciones en los apoyos plantares de estos niños tras el tratamiento osteopático, mediante la mejora de la movilidad a nivel de la pelvis o la intervención en la musculatura cervical. Material y métodos: Se llevó a cabo un ensayo clínico aleatorizado, doble ciego. Se estudió a 24 niños afectos de pie zambo, divididos en 3 grupos. Se realizó una técnica osteopática a cada uno de los dos grupos de intervención, y el tercer grupo fue un grupo control activo. Se realizó una baropodometría y una estabilometría mediante la plataforma podoprint aluminium antes e inmediatamente después de la aplicación de la técnica. Conclusiones: Los niños afectos de pie zambo unilateral presentan en su mayoría (9375%) un apoyo de peso sobre el retropié contralateral. En los casos bilaterales, el punto de máxima presión se localiza en el retropié derecho en un 50% de los casos. La modificación de tensiones a nivel pélvico, produjo mayores cambios en la distribución de cargas en los pies, que el tratamiento a nivel cervical
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Humanos , Preescolar , Niño , Pie Zambo/terapia , Osteopatía , Anomalías Musculoesqueléticas/terapia , Desarrollo de Músculos/fisiología , Medicina Osteopática , Equilibrio Postural/fisiología , Método Doble Ciego , 28599 , Estadísticas no ParamétricasRESUMEN
INTRODUCCIÓN: Nuestro objetivo es describir la experiencia adquirida en un programa de cooperación dedicado a la cirugía tiroidea en Camerún. Su interés radica en la imposibilidad para seguir las guías internacionales de tratamiento en áreas de recursos imitados debido a la falta de estudios preoperatorios y a la dificultad para conseguir medicación hormonal sustitutiva de por vida. MÉTODOS: Estudio observacional de una cohorte de 16 pacientes operados de enfermedad tiroidea en Dschang (Camerún) en junio de 2015. La técnica quirúrgica empleada fue la hemitiroidectomía con istmectomía en la enfermedad unilateral y la tiroidectomía subtotal bilateral en la enfermedad bilateral. RESULTADOS: Todos los pacientes eran de raza negra, 15 mujeres y un hombre, con edad media de 41 años. Se realizaron 5tiroidectomías subtotales, 9hemitiroidectomías y 2istmectomías. Cuatro pacientes presentaban componente intratorácico. Fue necesaria la sección de músculos pretiroideos en un caso. Se visualizaron las glándulas paratiroides y los nervios laríngeos recurrentes en el 86 y el 84% de los casos, respectivamente. Se dejaron drenajes en 7 casos y la mediana de duración de la intervención fue de 75 min. Como complicaciones cabe destacar un hematoma cervical que precisó reintervención y 2infecciones de herida quirúrgica. No hubo hipocalcemias clínicas ni lesiones recurrenciales apreciables. La estancia media fue de 2,3 días. A largo plazo, los pacientes con tiroidectomías bilaterales presentaban niveles elevados de TSH. CONCLUSIONES: La cirugía tiroidea en países subdesarrollados, adaptando los protocolos y técnicas que utilizamos en nuestro medio (evitando la tiroidectomía total), tiene una tasa de complicaciones asumible. No deben realizarse tiroidectomías bilaterales salvo que se disponga de estudios funcionales y se asegure previamente la disponibilidad de la hormona tiroidea
INTRODUCTION: The aim of this study is to demonstrate our experience at a volunteer surgical program in Cameroon, which is of special interest given to the inability to adopt international treatment guidelines for thyroid surgery in areas of limited resources due to the lack of preoperative testing and to the difficulty to obtain sustitutive hormonal treatment. METHODS: This is a prospective observational study that includes 16 cases of thyroid surgery in Dschang (Cameroon) during June 2015. The patients were previously selected by a local medical team. All patients were black, 15 women and one man, with a mean age of 41 years. The surgical technique used for the removal of unilateral disease was hemithyroidectomy with isthmectomy and bilateral subtotal thyroidectomy for bilateral disease. RESULTS: Five subtotal thyroidectomies, 9hemithyroidectomies and 2isthmectomies were performed. Prethyroid muscles were divided only in one case. We visualized 86% of the parathyroid glands and 84% of the recurrent laryngeal nerves. The main complications observed were one symptomatic cervical haematoma that required reoperation and 2surgical wound infections. There were no clinical episodes of hypocalemia or recurrent nerve lesion. The mean length of stay was 2.3 days. At follow-up, all bilateral thyroidectomies developed high TSH levels. CONCLUSIONS: Thyroid surgery is safe in developing countries adopting protocols and techniques we use in our environment (avoiding total thyroidectomy). Bilateral thyroidectomies should not be performed unless functional studies are available in the follow-up and a thyroid hormone supplement stock guaranteed whenever necessary