Evaluation of Hematoma Formation after Thyroidectomy Surgery and Its Related Factors.

Background: In the last decade, the number of patients undergoing thyroidectomy has increased. Compared to other methods, thyroidectomy is a relatively safe method for treating various types of thyroid diseases. However, the blood flow rate in the thyroid gland is high, and hematoma after thyroidectomy is one of its complications. We aimed to evaluate hematoma after thyroidectomy and its related factors. Methods: In this retrospective study, 2320 patients over 20 years of age who underwent thyroidectomy in Imam Khomeini, Arvand, and Mehr Ahvaz hospitals, Khuzestan Province, southern Iran between 2011 and 2022 were enrolled. Data were analyzed using SPSS software, version 22. Results: 70.7% of the patients were in the age range of 20-50 years. Twenty-five (1.1%) of patients developed a hematoma after thyroidectomy. Males are more likely to hematoma after surgery (P=0.01). Hematoma was significantly higher in patients with a history of hypertension (P=0.001). Moreover, a significant association was found between male gender, and age over 50 years with the risk of hematoma (P<0.05). The incidence of hematoma had a statistically remarkable correlation with follicular thyroid cancer pathology (P=0.001). Other pathology diagnoses were not significantly related to hematoma formation after thyroidectomy. Conclusions: Hematoma after thyroidectomy surgery is a rare, but dangerous and life-threatening complication. It is important to identify risk factors for hematoma formation.

Renal revascularization by a pedicled intestinal segment wrapping the kidney: a new method for kidney revascularization.

BACKGROUND: Renal artery stenosis is caused by a heterogeneous group of diseases, including atherosclerosis and fibromuscular dysplasia, which can be treated medically, via endovascular techniques, or by open revascularization; however, satisfactory and effective results are not always obtained. We aimed to assess the possibility of renal revascularization by a pedicled intestinal segment wrapping the kidney. METHODS: Five dogs were operated on at three steps. At the first step, laparotomy was performed, and the right kidney was released. Subsequently, an 8-10 cm segment of jejunum was separated longitudinally, and mucosectomy was done. This intestinal patch wrapped up the kidney. After eight weeks, the kidney and the intestinal patch were analyzed, and the renal artery was ligated. After four weeks, the kidney and the intestinal patch were sent for pathological evaluation. RESULTS: At the 12th week of evaluation, no evidence of abscess formation or collection was seen. All kidneys had a normal color, consistency, and size. All renal cells were alive, and neither atrophy nor necrosis was seen. Glomerulus and tubules were intact, and no inflammatory change was visible. Furthermore, thick wall vasculature was inspected in a fibromuscular tissue, rising from the intestinal flap toward the kidney. One of the dogs expired due to peritonitis and sepsis in the fifth week. CONCLUSION: In our study, indirect perfusion of the kidney by an intestinal patch was achieved successfully. This represents new hope in patients suffering from chronic renal failure who underwent former medical and surgical interventions with undesirable results.

COMPARISON BETWEEN INGUINAL HERNIOTOMIES WITH AND WITHOUT INCISING EXTERNAL OBLIQUE APONEUROSIS: A RANDOMIZED CLINICAL TRIAL.

BACKGROUND: Inguinal herniotomy is the most common surgery performed by pediatric surgeons. AIM: To compare the results and complications between two conventional methods of pediatric inguinal herniotomy with and without incising external oblique aponeurosis in terms of recurrence of hernia and other complications. METHODS: This one blinded clinical trial study was conducted on 800 patients with indirect inguinal hernia. Inclusion criterion was children with inguinal hernia. The first group underwent herniotomy without incising external oblique aponeurosis and second group herniotomy with incising external oblique aponeurosis. Recurrence of hernia and other complications including ileoinguinal nerve damage, hematoma, testicular atrophy, hydrocele, ischemic orchitis, and testicular ascent were evaluated. RESULTS: Recurrence and other complications with or without incising external oblique aponeurosis had no significant difference, exception made to hydrocele significantly differed between the two groups, higher in the incision group. CONCLUSION: Herniotomy without incising oblique aponeurosis can be appropriate choice and better than herniotomy with incising oblique aponeurosis. Children with inguinal herniotomy can be benefit without incising oblique aponeurosis, instead of more interventional traditional method.

Comparison between inguinal herniotomies with and without incising external oblique aponeurosis: a randomized clinical trial / Comparação entre herniotomias inguinais com e sem incisão da aponeurose do músculo oblíquo externo: um ensaio clínico randomizado

ABSTRACT Background: Inguinal herniotomy is the most common surgery performed by pediatric surgeons. Aim: To compare the results and complications between two conventional methods of pediatric inguinal herniotomy with and without incising external oblique aponeurosis in terms of recurrence of hernia and other complications. Methods: This one blinded clinical trial study was conducted on 800 patients with indirect inguinal hernia. Inclusion criterion was children with inguinal hernia. The first group underwent herniotomy without incising external oblique aponeurosis and second group herniotomy with incising external oblique aponeurosis. Recurrence of hernia and other complications including ileoinguinal nerve damage, hematoma, testicular atrophy, hydrocele, ischemic orchitis, and testicular ascent were evaluated. Results: Recurrence and other complications with or without incising external oblique aponeurosis had no significant difference, exception made to hydrocele significantly differed between the two groups, higher in the incision group. Conclusion: Herniotomy without incising oblique aponeurosis can be appropriate choice and better than herniotomy with incising oblique aponeurosis. Children with inguinal herniotomy can be benefit without incising oblique aponeurosis, instead of more interventional traditional method.

RESUMO Racional: Herniotomia inguinal é a operação mais comum realizada por cirurgiões pediátricos. Objetivo: Comparar os resultados e complicações entre dois métodos convencionais de herniotomia inguinal pediátrica, com e sem incisão de aponeurose oblíqua externa, em termos de recorrência de hérnia e outras complicações. Métodos: Este estudo cego foi realizado em 800 pacientes com hérnia inguinal indireta. Os critérios de inclusão foram crianças com hérnia inguinal. O primeiro grupo foi submetido à herniotomia sem incisão de aponeurose oblíqua externa e o segundo grupo herniotomia com ela. Foram avaliadas recorrência da hérnia e outras complicações, incluindo lesão do nervo ileoinguinal, hematoma, atrofia testicular, hidrocele, orquite isquêmica e ascensão testicular. Resultados: A recorrência e outras complicações com ou sem incisão da aponeurose oblíqua externa não apresentaram diferença significativa, com exceção feita à hidrocele significativamente diferenciada entre os dois grupos, maior no grupo com incisão. Conclusão: A herniotomia sem incisão da aponeurose do oblíquo externo pode ser escolha adequada e melhor do que a herniotomia com incisão dela. As crianças com herniotomia inguinal podem ser beneficiadas sem incisão da aponeurose, em vez do método tradicional mais intervencionista.