Benign goiters in surgery. A study of 815 cases.

Mali is a developing country of West Africa, located in an areawhere goiter is endemic.The aim of this work was to evaluate the quality of thyroid surgeryin our centre in Bamako between 1989 and 1997. This retrospectivestudy was based on the records of our centre and the results of investigationscarried out in the home of the patients living in Bamako.Results showed that from the exploitable 815 records 58.3% ofthe subjects lived in Bamako; 86.4% were women; the mean agewas 35 years (standard deviation : 13.5); 58.1% of goiters werehyperthyroid; 48.1% were euthyroid, and 1.8% hypothyroid; in45.8% of cases, the goiter was bilateral; the echography showed adiffuse goiter in 24.2% cases.Out of 401 operated patients, a subtotal thyroidectomy was performedin 41.6% of the cases; there was no total thyroidectomy forbenign goiters; the average weight of the removed goiters was 320gr.During the first 7 days following the operation, results were simplein 91.3% of the cases; 3.3% had a postoperative hemorrhage and1.5% had an infection of the operated area; other complicationswere 3.9 %. There was no mortality due to surgical cause, no tracheomalacia.There was 1.7 % of recurrent lesion according to thenumber of endangered nerves during the operation, and 1.1% ofclinical and biological hypoparathyroidism in the case of subtotalthyroidectomy.In the absence of systematic postoperative hormonotherapy, therewere 1.0 % recurrences after 3 years and 2.4% after 10 years.From these results, we confirm the usefulness of the systematicperoperative location of the recurrent nerve for its preservation; thesystematic location and protection of the parathyroid vascularization.In a developing country where geographical and/or economic accessibilityto the thyroid hormone is not easy, we propose to preserveas much as possible the upper pole of the thyroid lobe in case ofbenign pathology of the thyroid lobes, and to avoid the systematicprescription of the thyroid hormone after subtotal thyroidectomy.