title: Surgical treatment of endemic goiter in a nonhospital setting without general anesthesia in Africa.
abstract: BACKGROUND
  Endemic goiter remains a serious public health problem and 75 % of people affected live in underdeveloped countries where treatment is difficult for various reasons. The aim of this article is to report our experience in African countries with the management and surgical treatment of endemic goiter, performed in a nonhospital setting and without general anesthesia in the context of a collaborative development project by experienced endocrine surgeons.
  
  
  METHODS
  Fifty-six black African patients with a goiter were studied. Those in poor general health, the elderly, patients with either small goiters or clinical hyperthyroidism, and those presenting with an acute episode of malaria were excluded from the study. Cervical epidural anesthesia with spontaneous ventilation was used and a partial thyroidectomy was performed. The technique used, its immediate complications, and early and late follow-up were analyzed.
  
  
  RESULTS
  Surgery was performed on 31 patients with grades 3 and 4 goiter without mortality and a morbidity rate of 11.9 %, with 97 % of all complications being minor. There were no instances of dysphonia or symptomatic hypocalcemia and the mean stay was 1.57 days (range 1.25-1.93). Follow-up in the first year was 71 % and no case of severe or recurrent hypothyroidism was detected.
  
  
  CONCLUSIONS
  Surgery without general anesthesia performed in a nonhospital setting in underdeveloped countries in patients with goiter is a viable option with good results and low morbidity.
authors.affiliation: Surgery Department, Endocrine and GI Units, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain, pepegilmartinez@gmail.com.
authors.forename: J
authors.initials: J
authors.lastname: Gil
authors.forename: J M
authors.initials: JM
authors.lastname: Rodríguez
authors.forename: E
authors.initials: E
authors.lastname: Gil
authors.forename: M D
authors.initials: MD
authors.lastname: Balsalobre
authors.forename: Q
authors.initials: Q
authors.lastname: Hernández
authors.forename: F M
authors.initials: FM
authors.lastname: Gonzalez
authors.forename: J A
authors.initials: JA
authors.lastname: García
authors.forename: N
authors.initials: N
authors.lastname: Torregrosa
authors.forename: J A
authors.initials: JA
authors.lastname: Tortosa
authors.forename: A B
authors.initials: AB
authors.lastname: Diallo
authors.forename: P
authors.initials: P
authors.lastname: Parrilla
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000009:adverse effects; D000768:Anesthesia, General; D002163:Cameroon; D003906:Developing Countries; D005260:Female; D006043:Goiter, Endemic / Q000601:surgery*; D006268:Health Facilities; D006801:Humans; D007037:Hypothyroidism; D007902:Length of Stay; D008297:Male; D008302:Mali; D008875:Middle Aged; D009017:Morbidity; D013965:Thyroidectomy / Q000009:adverse effects / Q000379:methods*; D055815:Young Adult
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