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Article |

Reoperation for Persistent or Recurrent Primary Hyperparathyroidism

Wen Shen; Mete Düren, MD; Eugene Morita, MD; Charles Higgins, MD; Quan-Yang Duh, MD; Allan E. Siperstein, MD; Orlo H. Clark, MD
Arch Surg. 1996;131(8):861-869. doi:10.1001/archsurg.1996.01430200071013.
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Objective:  To analyze the causes and outcomes of reoperation for persistent or recurrent primary hyperparathyroidism.

Data Sources:  Medical records of 102 patients with persistent or recurrent primary hyperparathyroidism who underwent reoperation by 1 surgeon between 1985 and 1995.

Study Selection:  Only patients with persistent or recurrent primary hyperparathyroidism were selected; patients with secondary hyperparathyroidism, parathyroid cancer, familial hyperparathyroidism, and previous thyroid operations were omitted.

Data Extraction:  Performed by a single unblinded researcher.

Data Synthesis:  Reasons for failed parathyroid operations included tumor in ectopic position (53%), incomplete resection of multiple abnormal glands (37%), adenoma in normal position missed during previous surgery (7%), and regrowth of previously resected tumor (3%). Of the ectopic glands, 28% were paraesophageal, 26% in the mediastinum (nonthymic), 24% intrathymic, 11% intrathyroidal, 9% in the carotid sheath, and 2% in a high cervical position. Eighty-three percent of ectopic glands were accessible via cervical incision. The success rate of reoperations was 95%. One patient (1%) became permanently hypocalcemic after reoperation; 1 patient (1%) suffered permanent unilateral vocal cord paralysis. The sensitivities of preoperative localization studies were as follows: technetium Tc 99m sestamibi scan, 77%; magnetic resonance imaging, 77%; selective venous catheterization for intact parathyroid hormone, 77%; thalium-technetium scan, 68%; ultrasonography, 57%; and computed tomography, 42%.

Conclusions:  Repeated parathyroidectomy can be avoided in more than 95% of patients if an experienced surgeon performs bilateral cervical exploration during the initial parathyroid operation. For patients with persistent or recurrent primary hyperparathyroidism, preoperative localization studies and a focused surgical approach can result in a 95% success rate with minimum complications.Arch Surg. 1996;131:861-869


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