Thyroid surgery in Burkina Faso, West Africa: experience from a surgical help program

Abstract

Background: Endemic goiter caused by iodine deficiency is still very common in sub-Saharan Africa and is a surgical challenge because of the often large size of the goiters.

Methods: A retrospective analysis was made of patients who underwent operation for thyroid diseases during a surgical help program in Leo/Burkina Faso during a 7-year period from 2001 to 2008.

Results: A total of 253 cases presented with goiters grade III (WHO classification) were operated on: 134 hemithyroidectomies, 108 hemithyroidectomies combined with subtotal contralateral resection, and 11 total thyroidectomies were performed. The recurrent laryngeal injury rate was 0.8%, and the re-exploration rate for bleeding was 1.2%. Median hospital stay was 3.1 days. Histological examinations showed Graves' disease in 6 cases, and multinodular goiter in 231 cases. Follicular cancer was found in 15 cases, and anaplastic carcinoma was found in 1 case.

Conclusions: Thyroid surgery can be performed with low complication rates under basic surgical conditions. Because of the size and pathology of the goiters, total thyroidectomy is the method of choice. However, considering the risk of the development of hypothyroidism due to poor understanding or difficult access to medication, a limited resection, e.g., hemithyroidectomy, is the most optimal operative strategy.