Indications and Morbidity of Revision Thyroidectomy at Two Referral Hospitals in Sana’a City, Yemen

Export Objective: The aim of this study is to evaluate the indications and complications of revision thyroidectomy. Methods: This prospective descriptive study was conducted at Al-Thawra Modern General Hospital and Al-Kuwait University Hospital in Sana’a City, Yemen, between July 2019 and December 2022. All patients who underwent primary thyroidectomy and required revision thyroidectomy were recruited for the study. A clinical case sheet was used to gather data, which included demographic characteristics, preoperative variables (duration between both surgeries, clinical presentation, symptoms and signs, radiation exposure, investigations, and indications for reoperation), operative variables (side of reoperation and lymph node dissection), and postoperative variables (complications of revision thyroidectomy). The data were analyzed using Statistical Package for the Social Sciences. Results: A total of 35 (32 females and 3 males) patients with a mean age of 42.78±15.57 years participated in the study. The most frequent indication for reoperation was the recurrence of benign multinodular goiter (48.6%), followed by thyroid cancer diagnosed on the first surgical specimens (40%), and then the recurrence of thyroid cancer (11.4%). Patients who underwent reoperation to remove thyroid tissue from the ipsilateral side or both sides were more than those who underwent the reoperation to remove thyroid tissue from the contralateral side (60 vs. 40%). The majority of patients with malignant pathological examinations were subjected to lymph node dissection. The most frequent complication was transient hypocalcemia (25.7%), followed by transient hoarseness (5.7%). Permanent hoarseness, transient hypocalcemia, and tracheostomy were more common in patients who underwent bilateral reoperative surgery than those who underwent contralateral surgery. In contrast, transient hoarseness was more common in patients who underwent contralateral reoperative surgery than those who underwent bilateral surgery. Conclusions: Recurrent pathology and incidental carcinoma lead to higher rates of reoperation. Revision thyroidectomy is associated with a higher rate of complications, mostly transient hypocalcemia. In particular, revision thyroidectomy for malignancy is highly associated with lymph node dissection. Revision thyroidectomy following either malignancy or benignancy had no significant association with gender, type of revision thyroidectomy (contralateral and bilateral), and transient hypocalcemia complication. Complications of revision thyroidectomy are more associated with bilateral reoperative surgery than with contralateral surgery.