Reoperationen beim prim�ren Hyperparathyreoidismus

Abstract

While the initial treatment for primary hyperparathyroidism (pHPT), if managed by an experienced surgeon, is almost always successful, reoperations are challenging. Patients are at high risk for complications and the rates of success are plainly below those of primary cervical explorations. In this paper the reasons for failure during initial procedures are reviewed, as are the most important localization procedures and the prerequisites with regard to technical infrastructure as well as personnel, when planning repeat operations for a missed parathyroid adenoma. Provided that a standardized diagnostic and surgical approach is used, the surgeon is experienced, and up-to-date technical equipment is available, permanent normocalcemia following reoperations in pHPT is more frequently achieved than it used to be. The best option to avoid reoperations and associated complications is a successful initial intervention by an experienced surgeon. However, reoperations should always be performed by an experienced surgeon.

Virtual neck exploration in patients with hyperparathyroidism and former cervical operations

“…Although success rates of primary surgical therapy of hyperparathyroidism reach up to 98% in experienced hands for conventional four-gland surgery and 97% for focused minimally invasive surgery [2], still some patients require reoperation. Surgery for hyperparathyroidism in scarred tissue is challenging and associated with more complications when compared to patients undergoing initial surgery [4,5]. In patients with former thyroid resections, one or even more parathyroid glands may have been accidentally removed.…”

Failed Surgery in Primary Hyperparathyroidism - What has Changed with Time

“…"Preventable operative failures" -undetected SA in normal or ectopic positions -were signifi cantly more frequent in low-volume hospitals ( 13 vs. 89 % ) [ 33 ] . Karakas et al postulated the same, although they did not publish detailed data to prove this thesis [ 24 ] . Mitchell et al even wrote that many thyroid and parathyroid re-operations originating from low-volume centres were avoidable, and thus, operations in high-volume centres would decrease the number of re-operations [ 34 ] .…”

Reoperative surgery for primary hyperparathyroidism

“…Reoperation for persistent or recurrent pHPT is challenging; it is associated with high rates of recurrent laryngeal nerve palsy (RLNP) (4–10 per cent) and hypoparathyroidism (10–20 per cent), which is considered to be worse than mild hypercalcaemia4–7. There are several important points to consider in the management of a patient who has hypercalcaemia after a neck exploration for pHPT.…”

“…In a large series of reoperations abnormal parathyroid glands were found in orthotopic positions in 70 per cent of patients and in ectopic positions in about 25 per cent; supernumary glands were encountered in only 0·7 per cent6. In over 90 per cent the lesion is located in the neck or can at least be excised through a cervical incision7. An evaluation of vocal cord function by laryngoscopy is recommended before surgery.…”

“…The results of reoperative parathyroid surgery are not generally as good as those of first‐time surgery for pHPT. Several studies from tertiary referral centres report success rates of approximately 90 per cent after reoperation, with permanent RLNP in 3–10 per cent and hypoparathyroidism in 10–20 per cent4–7. National registries, however, such as that of the British Endocrine Society, suggest poorer outcomes.…”