Introduction: An esophagojejunal anastomotic leak following an oncological gastrectomy is a life-threatening complication, and its management is challenging. A stent application and endoscopic negative pressure therapy are possible therapeutic options. A clinical comparison of these strategies has been missing until now. Methods: A retrospective analysis of 14 consecutive patients endoscopically treated for an anastomotic leak after a gastrectomy between June 2014 and December 2019 was performed. Results: The mean time of the diagnosis of the leakage was 7.14 days after surgery. Five patients were selected for a covered stent, and nine patients received endoscopic negative pressure therapy. In the stent group, the mean number of endoscopies was 2.4, the mean duration of therapy was 26 days, and the mean time of hospitalization was 30 days. In patients treated with endoscopic negative pressure therapy, the mean number of endoscopies was 6.0, the mean days of therapy duration was 14.78, and the mean days of hospitalization was 38.11. Treatment was successful in all patients in the stent-based therapy group and in eight of nine patients in the negative pressure therapy group. Discussion: Good clinical results in preserving the anastomosis and providing sepsis control was achieved in all patients. Stent therapy resulted in anastomosis healing with a lower number of endoscopies, a shorter time of hospitalization, and rapid oral nutrition.

The surgical resection extension in well-differentiated thyroid cancer is controversially discussed with the possibility of an overtreatment on the one hand against the risk of local disease recurrence. The aim of this study is to evaluate how the surgical resection extension with the adjunction of radioiodine therapy affects postoperative morbidity and the oncologic outcome of patients primarily treated for well-differentiated thyroid cancer. All patients undergoing primary surgery for a well-differentiated, non-recurrent thyroid cancer from January 2005 to April 2013 at Tuebingen University Hospital were retrospectively analyzed. Papillary thyroid cancer (PTC) was present in 73 patients (including 27 papillary microcarinoma) and follicular thyroid cancer in 14 patients. Fifty-six of 87 patients (64%) underwent one-stage surgery, of which 26 patients (30%) received simultaneous lymph node dissection (LND). The remaining 31 patients (36%) underwent a two-stage completion surgery (29 patients with LND). Only in three patients a single lymph node metastasis was newly detected during two-stage completion surgery. Patients with LND at either one-stage and two-stage completion surgery had a significant higher rate of transient postoperative hypocalcemia. Postoperative adjuvant radioiodine therapy was performed in 68 of 87 patients (78%). After a median follow-up of 69 months [range 9–104], one local recurrence was documented in a patient suffering from PTC 23 months after surgery. No prophylactic two-stage lymphadenectomy should be performed in case of well-differentiated thyroid cancer to avoid unnecessary complication without any proven oncologic benefit.

Background: Small bowel perforations are a rare diagnosis compared with esophageal, gastric, and colonic perforations. However, small bowel perforations can be fatal if left untreated. A classification of small bowel perforations or treatment recommendations do not exist to date. Methods: A retrospective, monocentric, code-related data analysis of patients with small bowel perforations was performed for the period of 2010 to 2019. Results: Over a 10-year period, 267 cases of small bowel perforation in 257 patients (50.2% male and 49.8% female; mean age of 60.28 years) were documented. Perforation’s localization was 5% duodenal, 38% jejunal, 39% ileal, and 18% undocumented. Eight etiologies were differentiated: iatrogenic (41.9%), ischemic (20.6%), malignant (18.9%), inflammatory (8.2%), diverticula-associated (4.5%), traumatic (4.5%), foreign-body-associated (1.9%), and cryptical (1.5%) perforations. Operative treatment combined with antibiotics was the most commonly used therapeutic approach (94.3%). The mortality rate was 14.23%, with highest rate for patients with ischemic perforations. Discussion: An algorithm for diagnostic and therapeutic steps was established. Furthermore, it was found that small bowel perforations are rare events with poor outcomes. Time to diagnosis and grade of underlying disease are the most essential parameters to predict perforation-associated complications.

Background: Postoperative haemorrhage (POH) is a rare but potentially life-threatening complication of thyroid surgery, with an incidence of 0.6–4%. Early identification of patients at increased risk is critical to guide perioperative management, especially in the context of evolving surgical practices and increasing demand for outpatient procedures. Methods: We conducted an explorative, retrospective, single-centre case–control study using a prospectively documented quality assurance dataset including 9158 thyroidectomies (2012–2019). POH requiring revision (n = 104) were compared to matched controls (n = 416; 1:4 ratio), matched by age, sex, type of procedure (uni- vs. bilateral), and year of surgery. Univariate analysis (Chi-square and t-test) was used to identify possible associations between candidate risk factors and POH. To supplement classical univariate statistics, we applied a Random Forest machine learning model to assess the relative importance of 25 potential variables derived from the clinical dataset based on previous literature. It was also planned to use the results to develop a proposal for a quantitative risk score, system, assigning weights to each factor (3, 1, or 0 points) depending on their relative importance for predicting POH. Patients were subsequently categorized into risk classes (low, intermediate, high) based on total point scores and reclassified. Results: High-impact risk factors confirmed in univariate analysis and Random Forest modelling included reoperative thyroidectomy, smoking, relevant comorbidities, medical treatment for hyperthyroidism and advanced age and were weighted with 3 points. Moderately associated variables such as regular alcohol consumption, Graves’ disease, hyperthyroid state at surgery, duration of the procedure and thyroid weight were weighted 1 point. Factors with negligible predictive value (e.g., BMI, gender, ASA classification) were assigned 0 points. The average score among patients without haemorrhage was 5.21, whereas the average score among patients with haemorrhage was 7.61. Within the matched study cohort, patients with POH accumulated higher risk scores than controls, suggesting potential discriminatory capacity. These findings formed the basis for the development of an exploratory three-stage ‘traffic light’ risk stratification model that requires external validation. Conclusions: A simple, interpretable point-based scoring system derived from a large matched case–control cohort identified key predictors of postoperative hemorrhage (POH) after thyroid surgery and enabled risk stratification within the study population. By combining conventional statistical methods with machine-learning approaches, the score may support individualized perioperative monitoring, surgical planning, and institutional resource allocation. However, because the model was developed using a 1:4 matched case–control design, it should be considered an exploratory risk stratification tool rather than a fully validated prediction model, and it does not directly estimate absolute POH risk or population incidence. External and prospective validation in large, representative multicentre cohorts (e.g., StuDoQ, HEDOS) is ongoing and will be required to establish calibration, generalizability, and clinical utility.

Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of IONM, hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Retrospective analysis of prospectively documented data from a clinical quality assurance registry from June 2015 to May 2016 with a 12-month follow-up of all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ENT specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruiting from June 2015 to May 2016) and structured telephone interviews every 4-6weeks to assess the exact time course of PT-VCD recovery and VC status for periods of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6/2015 - 5/2016 there were 1097 consecutive thyroid procedures. During this period, there were 78 PT-VCD (1591 nerves at risk (NAR); 4,9 %) entered into the detailed follow-up-program. Of these, 3 PT-VCD persisted at 12 months (PT-VCD 0,18 % NAR), with 6 LOF (maximum rate of potentially persisting PT-VCD of 0,54% NAR). 15% of PT-VCD recovered within 4 weeks, mean recovery time was 4.4 months and 6 months after thyroidectomy 18 % still had impaired VC laryngoscopy tests. Individual cases were followed > 12 months showing late full recovery of PT-VCD, challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks 0.39 (95%CI 0.15-0.98), p= 0.046) and more specific, secondary ntLOS to be a significant independent predictor of PT-VCP recovery > 12 weeks (OR for recovery within 12 weeks 0.303 (95%CI 0.115-0.797), p= 0.016). Conclusion: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort and a correlation with operative data and IONM. We found that recovery takes a long time and non-transitory loss of signal – especially secondary ntLOS - during IONM was associated with prolonged PT-VCD recovery. Therefore, IONM provides an additional benefit and early initiation of speech therapy may be advisable for these patients.

Background: Post-thyroidectomy vocal cord dysfunction (PT-VCD) is an important side effect of thyroid surgery. With the introduction of intraoperative neuromonitoring (IONM), hopes have been raised that either the rate or severity of PT-VCD could be reduced. However, data to support these concepts are scarce. To better understand the relationship between IONM outcomes and the severity of PT-VCD, a detailed time-course evaluation of recovery of PT-VCD was performed in a continuous clinical quality registry from a specialized high-volume endocrine surgery center. Methods: Data were prospectively recorded in a single-center clinical quality assurance registry (June 2015 to May 2016) and subsequently analyzed retrospectively, with a 12-month follow-up for all cases. All patients underwent vocal cord (VC) laryngoscopy (VCL) by independent ear–nose–throat (ENT) specialists before and after surgery. Cases with newly diagnosed PT-VCD were enrolled in a detailed follow-up program (recruitment from June 2015 to May 2016) that included structured telephone interviews every 4–6 weeks to assess the exact time course of PT-VCD recovery and VC status for a period of at least 12 months. Clinical data were analyzed for variables affecting the time course of recovery by univariate analysis. Results: From 6/2015 to 5/2016 there were 1097 consecutive thyroid procedures. During this period, 78 cases of PT-VCD (1591 nerves at risk (NARs); 4.9%) were entered into the detailed follow-up-program. Of these, three cases of PT-VCD persisted at 12 months (PT-VCD 0.18% NAR), with six cases lost to follow-up (maximum rate of potentially persistent PT-VCD of 0.54% NAR). In total, 15% of PT-VCD cases recovered within 4 weeks; the mean recovery time was 4.4 months, and 6 months after thyroidectomy, 18% still had impaired VCL tests. Individual cases were followed >12 months showing late full recovery of PT-VCD, thereby challenging the definition of permanent VCD. Logistic regression analysis revealed non-transitory loss of signal (ntLOS) (OR for recovery within 12 weeks: 0.39; 95%CI 0.15–0.98; p = 0.046) and more specifically, secondary ntLOS, to be a significant independent predictor of PT-VCP recovery beyond 12 weeks (OR for recovery within 12 weeks 0.303; 95%CI 0.115–0.797; p = 0.016). Conclusions: For the first time, these data provide a detailed description of the time course of PT-VCD recovery in a large cohort, along with correlations to operative data and IONM findings. Our study indicates that recovery from PT-VCD can be prolonged, and specifically, the occurrence of ntLOS—especially secondary ntLOS—during IONM was predictive of a longer recovery trajectory. This suggests that IONM may offer an additional advantage by functioning as a prognostic tool, helping to identify patients at higher risk for extended recovery periods. Such early identification could enable a more targeted approach, potentially allowing for the earlier initiation of supportive interventions, like speech therapy, in those most likely to benefit from proactive management.