An unusual recurrent bilateral posterior mediastinal goiter after subtotal thyroidectomy: Case report

Introduction Surgical treatment of benign thyroid diseases need to be followed up closely, since recurrent thyroid nodules can be seen after subtotal thyroidectomy. Intrathoracic goiter (ITG) occurs in 10-30% of patients following subtotal thyroidectomy. In general these goiters are benign, having a malignant rate of only 2-22%. ITG grows slowly but steadily and in its process of development, it narrows the thoracic inlet by compressing the surrounding structures. Most of these can not located in the anterior mediastinum, others located in posterior retrovascular area. Bilateral posterior retrovascular goiters are very rare. PRESENTATION OF CASE We report a case involving a 61-year-old woman with history of gradual-onset dyspnea who was referred to us for evaluation of a large mediastinal mass. She had undergone bilateral thyroid lobectomy for a cervical goiter 10 years ago. The mass was removed successfully via median sternotomy without complication. The patient recovered well and was discharged in 1 week. DISCUSSION Most anterior mediastinal goiters can be resected through a transcervical approach, but if those extending beyond the aortic arch into the posterior mediastinum are better dealt with by sternotomy or lateral thoracotomy. CONCLUSION Bilateral recurrent posterior mediastinal and retrovascular large goiters are better resected via sternotomy rather than lateral thoracotomy. The reason for that are the possibility of injury to large vascular structures and the difficulty of their management through lateral thoracotomy when cardiopulmonary bypass needed. © 2014 The Authors

Laparoscopic sleeve gastrectomy on a morbidly obese patient with situs inversus totalis: A case study and systematic review of the literature

PMID = 2803469

A Preventive Strategy for Staple Line Bleeding in Morbidly Obese Patients Undergoing Sleeve Gastrectomy

PMID = 2882922

Which Suture Material is Optimal for Pancreaticojejunostomy Anastomosis? An In Vitro Study

PMID = 2778037

Porto-mesenteric venous thrombosis after laparoscopic sleeve gastrectomy: A case report and systematic review of the 104 cases

PMID = 2931097

A new preoperative categorization and potential preoperative indicator for cysto-biliary fistula in hydatid hepatic disease

The objective of this study was to determine the risk for cysto-biliary fistula (CBF) and preoperative predictive factors in patients with hepatic hydatid disease (HHD) with high levels of hepatobiliary enzymes (HLE) alone. The risk of CBF and predictive factors in patients with HHD whose only sign of fistula was HLE is unknown. A total of 116 patients without clinical and radiologic signs who were operated for HHD were categorized into 2 groups: patients with and without HLE. The patients with HLE were defined as "usual suspicious." The potential preoperatively predictive factors for CBF were retrospectively analyzed in this group. Our data included 18.1% of patients (n = 21) with CBF and 69.2% of patients (n = 81) with HLE. The usual suspicious group contained 24.7% of patients (n = 20) with CBF. The risk of CBF was 11-fold higher in the usual suspicious group (95% confidence interval, 1.4-86.7). The red cell distribution width (RDW) was higher in patients with CBF than in patients without CBF in the usual suspicious group (P = 0.006). The performance of the RDW, with a cutoff value of 13.75%, was found to be suboptimal for predicting CBF for patients in the usual suspicious group (area under the curve, 0.661; 95% confidence interval, 0.525-0.798). We defined a new preoperatively high-risk group with HLE alone; this definition can help to identify patients at risk for preoperatively undetectable CBF. The RDW was not found to be sufficient for the discrimination of usual suspicious group with CBF. © 2016, International College of Surgeons. All rights reserved

Effectiveness of Limberg and Karydakis flap in recurrent pilonidal sinus disease

OBJECTIVE: Sacrococcygeal pilonidal sinus is common in young men and may recur over time after surgery. We investigated whether a factor exists that can aid in the determination of the preferred technique between the early Limberg flap and Karydakis flap techniques for treating recurrent pilonidal sinus. MATERIALS AND METHODS: This prospective and randomized study enrolled 71 patients with recurrent pilonidal sinus in whom the Limberg flap or Karydakis flap techniques were applied for reconstruction after excision. Patients were divided into two groups as follows: 37 patients were treated with the Limberg flap technique and 34 patients were treated with the Karydakis flap technique. Fluid collection, wound infection, flap edema, hematoma, partial wound separation, return to daily activities, pain score, complete healing time, painless seating and patient satisfaction were compared between the groups. ClinicalTrial.gov: NCT02287935. RESULTS: The development rates of total fluid collection, wound infection, flap edema, hematoma, and partial wound separation were 9.8%, 16%, 7%, 15% and 4.2%, respectively; total flap necrosis was not observed in any patient (p<0.001). During the average follow-up of 28 months, no patients (0%) developed recurrent disease. The two groups differed with respect to early surgical complications (p<0.001). CONCLUSION: In this study, use of the Limberg flap was associated with lower complication rates, shorter length of hospital stay, early return to work, low pain score, high patient satisfaction and better complete healing duration. Therefore, we recommend the Limberg flap for treatment of recurrent pilonidal sinus