Causes of failure in the surgical treatment of primary hyperparathyroidism: Lessons from 51 successful reoperations

Vroonhoven, T J van; Müller, H. L.

doi:10.1002/bjs.1800650502

Cited by 21 publications

(3 citation statements)

References 11 publications

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“…In the vast majority of cases, however, mediastinal parathyroid glands can be resected via a cervical approach. [4][5][6][7][8][9][10] The remaining patients have traditionally been treated with median sternotomy, although thoracotomy, [10][11][12][13] anterior mediastinotomy, 14 transcatheter ablation, 15 and various videoassisted techniques 10,16,17 have also been used.…”

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Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease

2006

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Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease

2006

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“…The first large series of mediastinal hyperfunctioning parathyroid tumors was reported by Nathaniels et al in 1970 [1]. From this report and from other surgical papers published subsequently [2][3][4][5][6] as well as from anatomic studies [7][8][9], the following conclusions can be drawn: (a) there is a substantial number of normal parathyroid glands as well as parathyroid tumors located in the mediastinum (2-20%), mostly within or close to the thymus [1,6,[7][8][9]; (b) most mediastinal parathyroid tumors can be removed from the neck mainly by partial or complete cervical thymectomy [10, 11 >; (c) during reoperative surgery most tumors are found in the neck [3][4][5]12 ]; and (d) item (b) is also true for reoperative surgery and only a small percentage of patients (2-22%) require sternotomy [3][4][5].…”

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confidence: 65%

Median sternotomy in reoperations for primary hyperparathyroidism

1985

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Thirty-three patients underwent median sternotomy at reoperation for persistent or recurrent hyperparathyroidism. Radiographic studies correctly localized abnormal tissue to the mediastinum in 21 patients and surgery was successful in 19 of them. In the 12 patients without preoperative Iocalization, surgery was successful in 9. Twentysix of 29 patients with a diagnosis of parathyroid adenoma had successful surgery, while only 2 of 4 patients with hyperplasia had successful procedures. In 10 patients the median sternotomy proved unnecessary since the parathyroid abnormality was located at a site reachable through the cervical incision. Abnormai parathyroid glands were found in the thymus (21), posterior to the thymus along the arch (6), within the thyroid (4), and at other ectopic locations. Abnormal parathyroid glands found within the thymus were often smaller than 1 cm in diameter and were detected by the pathologist after dissecting the entire thymus, indicating the need for total thymectomy. The complication rate was 12%, and the mortality rate was 6%. Initial operations for primary and secondary hyperparathyroidism are successful in 95-98% of cases [1]. In most patients undergoing reexploration for persistent or recurrent hyperparathyroidism, the hyperfunctioning parathyroid gland will be found in the neck [2]. In 21 (60%) of 35 patients reported by Beazley and associates [3] and 25 (49%) of 51 patients reported by van Vroonhoven et al. [4] undergoing reoperation for hyperparathyroidism, the abnormal parathyroid glands were located in a normal position. Even when ectopic parathyroid

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“…Edis et al suggested that the reason for the unsuccessful initial exploration is "failure on the part of the surgeon to appreciate the nuances and variations of normal parathyroid anatomy" [13]. This point of view is supported by several reported series of reexploration where the missing gland was subsequently located in a normal anatomical position in up to 60% of cases [7,14,15]. This simple comment, however, understates what most surgeons regard as a complex problem.…”

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The challenge of the middle mediastinal parathyroid

et al. 1988

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In most cases of persistent or recurrent hyperparathyroidism (HPT), the pathological parathyroid (PT) will be in the neck or accessible through the cervical approach, and in only a small percentage will median sternotomy be required. We present 3 cases of persistent HPT where the PT tissue was in the middle mediastinum. We acknowledge that this is a rare occurrence and that it cannot be explained adequately by standard embryological teaching. In cases requiring formal mediastinal exploration, the mediastinai exploration is not complete unless the middle mediastinum is carefully explored to exclude ectopic PT tissue.

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Causes of failure in the surgical treatment of primary hyperparathyroidism: Lessons from 51 successful reoperations

Cited by 21 publications

References 11 publications

Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease

Partial Median Sternotomy: An Attractive Approach to Mediastinal Parathyroid Disease

Median sternotomy in reoperations for primary hyperparathyroidism

The challenge of the middle mediastinal parathyroid

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