To assess the incidence, indications and complications of reoperative thyroid gland surgery we have retrospectively analyzed 1102 patients from the period 1983-1992. There were 148 reoperations (13%). The indications for reoperation showed an increase of premalignant and malignant tumors and a decrease of hyperthyroid disorders and of thyroiditis in +17%, -15% and -2% respectively. Indications for nodular goiters were identical for primary and secondary surgery. Newly discovered cancer accounted for 12 cases (9.2%) out of 35 reoperations for carcinoma. The rate of recurrent laryngeal nerve palsies for primary and secondary operations was 2% and 4% respectively. 19% of the patients undergoing reoperations had a preexisting unilateral nerve palsy. The rate of permanent hypoparathyroidism was 0.5% and was not influenced by the type of resection. Postoperative hypothyroidism depended on the extent of resection. The high rate of reoperations for benign goiters and the new data on goitrogenesis has directed our policy toward more extensive resection of nodular thyroid tissue. Since January 1991 this approach has increased the rate of lobectomies from the previous 27% to over 50% without increased morbidity. For reoperations we prefer the lateral cervical approach, to avoid ventral scarring from the former Kocher incision.
Conclusion: Extensive resection of nodular tissue during the initial operation reduces the rate of recurrent goiters and subsequently the rate of reoperations, eliminating the high morbidity of reoperative thyroid surgery. Extensive resection with at least unilateral lobectomy can be performed safely. Indications for reoperation should be strict and, when unavoidable, a lateral approach should be chosen.