Further Locations Prone to Iatrogenic Nerve Injuries
According to the review article (1), iatrogenic nerve injuries can be caused by transection, crushing and compression, penetration, and twisting by screws. Among the procedures associated with iatrogenic nerve injury, herniotomy is described as a major abdominal surgical procedure. This view certainly differs from the general perception, as inguinal hernia repair is a procedure which should typically be performed on a day surgery basis, according to the Social Security Code (SGB). On the other hand, the review does not mention other abdominal and vascular surgical procedures at all.
Indisputably, the best evaluated data material is available for the 90 000 thyroid surgeries performed in Germany each year. A recent multicenter study reports an incidence of transient and permanent recurrent laryngeal nerve palsy of 2–4%. Since patients undergoing thyroid surgery are typically seen by an ENT specialist before and after the operation, these data are unquestionably valid. Thus, the incidence of nerve injury during thyroid surgery is certainly much higher than the rate stated in Table 1.
Another intriguing aspect is related to the approximately 35 000 carotid artery surgeries performed in Germany each year. Peripheral nerve injury is one of the risks associated with the surgical treatment of carotid artery stenosis. Most commonly, the hypoglossal nerve is injured. The evaluation of peripheral nerve injuries is especially relevant as there is ongoing controversy whether carotid artery stenosis should be treated surgically or with a stent.
Even though the authors did apparently not attempt surgical repair of such nerve injuries, they should at least have been mentioned them in their discussion.
Prof. Dr. med. Heiner H. Wenk
Zentrum für Chirurgie – Allgemein-, Gefäß- und Visceralchirurgie
Klinikum Bremen-Nord, Bremen
|1.||Antoniadis G, Kretschmer T, Pedro MT, König RW, Heinen CPG, Richter HP: Iatrogenic neurological damage—prevalence, diagnosis and treatment. Dtsch Arztebl Int 2014; 111: 273–9. VOLLTEXT|