Hereditary hyperparathyroidism typically presents at an earlier age than the sporadic variants. Gene penetrance and expressivity varies. Parathyroid multiple gland involvement is common, but in some variants, it may occur metachronously often with long disease-free intervals, simulating a single-gland involvement. Bilateral neck exploration with subtotal parathyroidectomy or total parathyroidectomy + autotransplantation should be performed, especially in MEN 1, in order to decrease the persistent and recurrent hyperparathyroidism rates; in some variants (MEN 2A, HPT-JT), limited parathyroidectomy can achieve long-term normocalcemia. In FHH, surgery is contraindicated; in NSHPT, urgent total parathyroidectomy is required. In FIHPT, MEN 4 and ADMH, a tailored case-specific approach is recommended.

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There is a significant difference in postoperative hypocalcemia rates between those with vitamin D levels>50 nmol/l (>20 ng/ml) and those with a level of <25 nmol/l (<10 ng/ml). Vitamin D deficiency leads to a delay in discharge owing to a higher likelihood of hypocalcemia.

Background: Postoperative pain associated with open haemorrhoidectomy remains problematic. Haemorrhoidectomy performed using bloodless bipolar diathermy ± Ligasure TM ± may have advantages over conventional open haemorrhoidectomy in terms of operating time and postoperative pain.Methods: Thirty-four patients were randomized to undergo Ligasure TM (18 patients) or diathermy (16) haemorrhoidectomy. The operating time, amount of pain and postoperative analgesic requirement, postoperative complications and overall patient satisfaction were documented.Results: The median duration of operation was shorter in the Ligasure TM haemorrhoidectomy group (5´1 versus 9´2 min; P < 0´001). There was no statistically signi®cant difference in the postoperative pain score, but the median analgesic requirement was lower in the Ligasure TM group (850 versus 1600 mg tramadol; P = 0´013). Patient satisfaction was similar in both groups.Conclusion: Ligasure TM haemorrhoidectomy is quick and bloodless and, although as painful as diathermy haemorrhoidectomy, is associated with a reduced analgesic requirement.