Fualal Jane Odubu
Mulago National Referral and Teaching Hospital, Uganda
Title: Challenges impacting giant goiter surgery at a tertiary Sub-Saharan Hospital
Biography
Biography: Fualal Jane Odubu
Abstract
Thyroid disease is prevalent in Africa. Regional governments’ and NGO’s effort to establish tertiary institutions and facilitate surgical outreaches have yielded little. Globally, health funding faces scarcity. Third world countries have been identified with neglected thyroid disease like big goiters causing disfigurements, upper airway and gastrointestinal tract obstruction or neck vasculature engorgement. Longstanding cases may undergo malignant transformation or extend retrosternally. This was a prospective cohort selected from a pool of operated thyroid patients at Breast and Endocrine Unit of Mulago National Referral and Teaching Hospital, Kampala Uganda. Averagely, six (6) thyroidectomies are done every week. Two (2) out of these qualified for the study as having giant goiter. Surgery necessitated the team’s lobbying for ICU space, meticulous peri-operative involvement of anesthesiology residents and undertaking thorough investigations. Age range of patients was 15 – 70 years with majority in the 40-60 year age bracket; a female preponderance of 8:1. Average operative time was 4hours with about half utilized by anesthesia. Challenges encountered included team building, scarce surgical instruments, managing difficult airway, extracting impacted retrosternal goitre, encountering the markedly engorged neck vessels and ICU space. Loss to follow up after discharge was about 30%. Despite innumerable challenges, the result shows that 95% of our patients get successful surgery; 4% develop transient complications like hoarseness and hypocalcaemia. One patient required tracheostomy. Giant thyroid is fairly common at Mulago. Its surgery is challenging. With organized team, competence, overall surgical results are comparable to those in well facilitated centers even amidst scarce resources.