Parathyroidectomy in the treatment of patients with chronic renal failure: A 10-year review

Abstract

The technique and outcome of surgery for the manifestations of secondary hyperparathyroidism are described. Forty-seven patients were analysed retrospectively over a 10-year period. Total parathyroidectomy and autotransplantation to the forearm was performed in all but five patients. Improvement occurred in 87 per cent of patients and there were no graft failures. Of six deaths, none was related to surgery. Four patients had recurrent hyperparathyroidism, three being graft dependent and one requiring re-exploration of the neck. Total parathyroidectomy and autotransplantation is a safe and effective approach. The major management problem was graft hyperplasia, seen in three of the 47 patients and managed by simple excision.

Total parathyroidectomy without autotransplantation as a standard procedure in the treatment of secondary hyperparathyroidism

“…It is well known from the literature that oral supplementation is required even in a significant proportion of patients undergoing autografting or subtotal parathyroidectomy to balance serum calcium and phosphorus [32,33] due to the development of a "hungry bone" after surgery. Vitamin D analogues, in addition to replacement therapy, is indicated in long-term to suppress inadequate PTH secretion, thereby protecting against recurrent disease [34]. In our series perioperative medical management was identical in both groups and severe hypocalcemia did not occur because high-dose calcitriol was routinely given before surgery.…”

Parathyroidectomy in Chronic Renal Failure: Short- and Long-Term Results on Parathyroid Function, Blood Pressure and Anemia

“…Therefore, criteria of evaluation of the outcome of surgery were essentially clinical, that is based on the fall in serum calcium, and on radiological and general improvement; for example, Rothmund et al [23]judged the outcome clinically without mention of PTH results. A similar approach was used by other researchers [22, 24]. …”

Total parathyroidectomy without autotransplantation for renal hyperparathyroidism

“…Forearm grafts can be difficult to excise and other centres have reported autotransplantation with the need for multiple operations to establish control of increasing PTH levels8, 14, 23. Recurrence following total parathyroidectomy with autotransplantation is located in the forearm autograft in approximately 80 per cent of cases24, 25.…”