Reliability of Targeted Surgical Approach in the Treatment of Primary Hyperparathyroidism

Abstract

Introduction: It is estimated that the prevalence of primary hyperparathyroidism in patients over 40 years is about 1 % (men 0.4 %, women 1.6 %). Despite developments in diagnosis today, the highest percentage of patients with hyperparathyroidism remains undetected, and it is estimated that only 10% of cases are diagnosed and treated. In 90% of patients, the cause of hyperparathyroidism is one pathologycally changed parathyroid gland. Aim of the Study: To estimate the efficiency and reliability of a conservative approach in surgical treatment, previously diagnosed with primary hyperparathyroidism, in comparison to a traditional neck exploration showing all four parathyroid glands. Patients and Methods: In the study, we analyzed the results of 71 patients at the University Clinical Center of the Republic of Srpska in the period from 2008 to 2017. The diagnosis of primary hyperparathyroidism was set based on the ultrasonography and scintigraphy of parathyroid glands, neck CT scan, clinical pictures and laboratory findings. The surgery included short cervical incision of 2 cm and 4 cm, placed 2 cm above the jugulum with unilateral neck exploration and extirpation of modified parathyroid gland. Results: In the research were used classification methods, structural-functional analysis, synthesis, comparisons, abstractions, concretisations and simpler statistical method with the use of descriptive statistics to prove the hypothesis set, out of which tables, grafs, and summaries were used. 71 patients diagnosed with primary hyperparathyroidism were operated. The youngest patient was 28-year-old and the oldest 79-year-old. On the basis of the PH findings, targeted parathyroidectomy procedure was successful in 94.3% cases. Conclusion: The goal of the surgical approach, with unilateral neck exploration, allows successful identification of pathologically modified parathyroid gland and efficient treatment of primary hyperparathyroidism.