Reoperation for Primary Hyperparathyroidism

McGarity, William C.; Goldman, Alan L.

doi:10.1097/00000658-198108000-00003

Cited by 19 publications

(5 citation statements)

References 6 publications

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“…One patient with a 100-mg gland with persistent hypercalcaemia, which subsided after an exploratory sternotomy performed elsewhere One patient with cervical parathyreomatosis In our study, five patients harboured double adenomas (three bilateral) and one triple adenomas, i. e. in six patients with multiple adenomas, at least one had been overlooked at the first operation [15,16]. We classified the reasons for the failed primary parathyroid operation in to five subsets:…”

Section: Results Of Reoperationmentioning

confidence: 99%

Reoperation for persistent or recurrent primary hyperparathyroidism

Mariette

Pellissier

Combemale

et al. 1998

Langenbecks Arch Chir

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Aim: To analyse the causes and outcome of reoperations for persistent or recurrent primary hyperparathyroidism (HPT). Materials and methods: We reviewed the medical records of 38 patients who underwent reoperation between December 1965 and April 1997 for persistent or recurrent primary HPT. During this period of time, 1448 patients underwent operation for primary HPT, 294 for renal HPT and 58 for questionable disease, i. e. a total of 1800. In the 1448 cases of HPT, 22 patients were reoperated after a first cervicotomy in the institution, i. e. a first reoperation rate of 1.5%. Sixteen patients were referred after unsuccessful parathyroid surgery. Six patients were reoperated on twice and one patient seven times for a graftdependent recurrence. Results: Reasons for failed parathyroid operations included tumour tissue in ectopic location (75%) or tumour tissue that had not been seen in normal position (19%), parathyreomatosis (2%), parathyroid cancer (2%) and graft-dependent hypercalcaemia (2%). Of the ectopic glands, 45% were intrathymic, 12.5% intrathyroidal, 7.5% retro-oesophageal, 7.5% in the carotid sheath, 5% interthyrotracheal, 5% in the mediastinum (extrathymic), 5% in the aorto-pulmonary window, 2.5% undescended, 2.5% overdescended and 2.5% intertracheooesophageal. Of the patients, 38% had uniglandular lesions, 60% multiglandular lesions, and 2% parathyroid cancer. The histologically confirmed cause of HPT was adenoma in 50% of cases, hyperplasia in 38% and "normal" but overweight glands in 9.5%. Of the 38 patients studied, 15 presented one or more supernumerary glands (fifth to eighth gland). Reoperation was performed through a cervical incision in 82% of cases and using a mediastinal approach in 18% (8 median sternotomies, 1 thoracoscopy). The success rate of the reoperations was 92%. A total of 8% of patients suffered permanent unilateral vocal cord paralysis; 5% are definitely hypocalcaemic. The sensitivities of preoperative localization studies ranged from 69% for sestamibi scan and 63% for selective venous catheterization to 16% for computed tomography. Conclusion: Repeated parathyroidectomy can be avoided in more than 98% of patients if an experienced surgeon performs bilateral cervical exploration during the initial parathyroid operation. For patients with persistent or recurrent primary HPT, preoperative localization studies and a focused surgical approach can result in a 92% success rate with a minimal complication rate.

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Section: Results Of Reoperationmentioning

confidence: 99%

Reoperation for persistent or recurrent primary hyperparathyroidism

Mariette

Pellissier

Combemale

et al. 1998

Langenbecks Arch Chir

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“…2 bis 10 % der misslungenen chirurgischen Eingriffe beruhen auf einer falschen Diagnose [4]. Heutzutage verliert dieses Prob-…”

Section: Schlussfolgerungen Für Die Klinische Praxisunclassified

Chirurgische Therapie des primären Hyperparathyreoidismus und dessen Komplikationen: Erfahrungen an 453 Patienten

Adámek¹,

Libánský²,

Naňka³

et al. 2005

Zentralbl Chir

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453 patients underwent surgery for primary hyperparathyreoidism between 1994 and 2003. In all patients, biochemical parameters were monitored and X-ray with USG of the neck was done. Struma nodosa was concommitantly present in 48 % of treated patients with primary hyperparathyroidism. In such cases, MRI offers better resolution of soft tissues. 98.6 % of treated patients had postoperative decrease of blood calcium to normal level. 5.4 % of cases were reoperations for primary hyperparathyroidism. In 12 % of cases, pathologically changed parathyroid glands in dystopic localization were found. In these dystopic localizations, pathologic parathyroid glands were found: in 3 % intrathyroid, in 7 % mediastinal and in 2 % of all 453 cases in other localization. In 4 % of patients, sternotomy was necessary. Persistent hypocalcemia was not registered in any patient. Transient hypocalcemia with necessity of infusion therapy was observed in 3.5 % of patients. Postoperative hypercalcemia persisted in 1.2 % of patients. Recurrent hypercalcemia was present in 0.2 % of cases. In three cases (0.7 %), unilateral injury of recurrent laryngeal nerve was observed.

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“…The physical and financial costs associated with reoperative parathyroid surgery are well known, and advocates for the bilateral approach highlight the potential morbidity that can be avoided with a single operation [69][70][71]. Typically patients with failed explorations are subjected to an exhaustive preoperative work-up in an attempt to localize the pathology, possibly including repeat sestamibi or ultrasound, CT, MRI, PET, and angiography with selective venous sampling [10,11].…”

Section: Bilateral Explorationmentioning

confidence: 99%