Secondary Hyperparathyroidism: Surgical

Yoo, John; Young, Jack

doi:10.1007/978-1-4614-2164-1_10

Cited by 2 publications

(5 citation statements)

References 103 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Besides relevant expenditure, costs and logistic challenges, cryopreservation maintenance is, in some countries, further complicated by extensive procedural, ethical and legal licensing terms. Nevertheless, in rare occasions when cryopreserved parathyroid tissue is successfully reimplanted, permanent hypoparathyroidism may be prevented [79]. Thus, cryopreservation is not necessary for the standard PTX procedures performed for renal HPT, despite distinct situations such as conceivable problems with access or intolerance to substitution, while it appears recommendable to inform the patient whether provision of cryopreservation is available (EL 3; RG C) ( Table 7).…”

Section: Surgical Treatment Of Patients With Renal Hyperparathyroidismentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

View full text Add to dashboard Cite

Background Despite advances in the medical management of secondary hyperparathyroidism due to chronic renal failure and dialysis (renal hyperparathyroidism), parathyroid surgery remains an important treatment option in the spectrum of the disease. Patients with severe and complicated renal hyperparathyroidism (HPT), refractory or intolerant to medical therapy and patients with specific requirements in prospect of or excluded from renal transplantation may require parathyroidectomy for renal hyperparathyroidism. Methods Present standard and actual controversial issues regarding surgical treatment of patients with hyperparathyroidism due to chronic renal failure were identified, and pertinent literature was searched and reviewed. Whenever applicable, evaluation of the level of evidence concerning diagnosis and management of renal hyperparathyroidism according to standard criteria and recommendation grading were employed. Results were discussed at the 6th Workshop of the European Society of Endocrine Surgeons entitled Hyperparathyroidism due to multiple gland disease: An evidence-based perspective.Results Presently, literature reveals scant data, especially, no prospective randomized studies to provide sufficient levels of evidence to substantiate recommendations for surgery in renal hyperparathyroidism. Appropriate surgical management of renal hyperparathyroidism involves standard bilateral exploration with bilateral cervical thymectomy and a spectrum of four standardized types of parathyroid resection that reveal comparable outcome results with regard to levels of evidence and recommendation. Specific patient requirements may favour one over the other procedure according to individualized demands. Conclusions Surgery for patients with renal hyperparathyroidism in the era of calcimimetics continues to play an important role in selected patients and achieves efficient control of hyperparathyroidism. The overall success rate and longterm control of renal hyperparathyroidism and optimal handling of postoperative metabolic effects also depend on the timely indication, individually suitable type of parathyroid resection and specialized endocrine surgery.

show abstract

Section: Surgical Treatment Of Patients With Renal Hyperparathyroidismentioning

confidence: 99%

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Lorenz

Bartsch

Sancho

et al. 2015

Langenbecks Arch Surg

108

130

View full text Add to dashboard Cite

show abstract

“…These include subtotal parathyroidectomy (STP), total parathyroidectomy with autotransplantation (TPAT) and total parathyroidectomy without autotransplantation (TP) [ 1 ]. In STP all hyperplastic parathyroid glands are removed except for a small remnant of vascularized parathyroid tissue (50 mg), which is left inside the thyroid bed [ 7 , 8 ]. The blood supply and neurovascular relationship of the parathyroid glands has been well described.…”

Section: Introductionmentioning

confidence: 99%

“…The main advantage of STP is the maintenance of the native blood supply to the remnant parathyroid gland, hence preserving the ability of the remnant gland to continue secreting PTH hormone. This reduces the severity and duration of symptomatic hypocalcaemia that may result in the post-operative period [ 8 , 11 ]. An additional advantage of this technique may be a lower incidence of recurrences as compared to TPAT [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

“…An additional advantage of this technique may be a lower incidence of recurrences as compared to TPAT [ 12 ]. The major disadvantage with STP is the difficulty in re-exploration of the thyroid bed for recurrent disease, with the potential of injury to the RLN [ 8 ]. Unfortunately, with continued dialysis, recurrence of HSRF is a frequent occurrence regardless of initial surgical technique, and may be caused by proliferation of the remnant or autotransplanted parathyroid tissue or a supernumerary gland [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

“…On a recent meta-analysis the rate of recurrent disease was found to be higher for TPAT as compared to STP [ 12 ]. In addition, there is often a delay in return of the parathyroid function since the autotransplanted parathyroid tissue requires recruitment of new blood supply from the host bed to regain function [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: Modification of a traditional operation

Low

Yoo

2017

Journal of Otolaryngology - Head & Neck Surgery

Self Cite

View full text Add to dashboard Cite

BackgroundWe describe a modification of the conventional subtotal parathyroidectomy operation where the parathyroid gland(s) remnant is repositioned with intact vascular supply to a plane superficial to the infrahyoid strap muscles and immediately under the skin incision. This technique called Subtotal Parathyroidectomy and Remnant Relocation (SPARE) retains all the metabolic advantages of the conventional operation with the added advantage of easier identification of a recurrent hyperplastic remnant if re-exploration becomes necessary.MethodsIn the SPARE technique, four parathyroid glands were identified and the quality of each gland and the length of each vascular pedicle to the parathyroid glands were assessed. The optimal parathyroid gland was relocated to a plane superficial to the strap muscles. The remainder of the glands were removed.ResultsIn total, 30 patients with hyperparathyroidism secondary to renal failure (HSRF) underwent parathyroidectomy with the SPARE technique. The mean age was 53.1±12.5 years and median follow-up was 17.1 months (range 1-78.9 months). There were no recurrent laryngeal nerve (RLN) injuries or hematomas. The pre- and post-operative value for corrected calcium and PTH were 158.4±109.4 pmol/L and 11.4±12.1 pmol/L, respectively (p < 0.05). Three recurrences were noted (10.0%), with a mean time to recurrence of 15.3±6.6 months. One patient had excision of the remnant parathyroid glands performed under local anaesthetic (29 min); one had re-exploration performed under general anaesthetic (81 min), and one was managed medically.ConclusionWe described a novel parathyroidectomy technique for patients with HSRF, which provides the advantages of conventional subtotal parathyroidectomy while mitigating the challenges of thyroid bed re-exploration when recurrences arise.

show abstract

Secondary Hyperparathyroidism: Surgical

Cited by 2 publications

References 103 publications

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

Subtotal Parathyroidectomy and Relocation of the Parathyroid Remnant for Renal Hyperparathyroidism: Modification of a traditional operation

Contact Info

Product

Resources

About