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Article |

Efficacy of Selective Unilateral Exploration in Hyperparathyroidism Based on Localization Tests

John A. Ryan Jr, MD; Brian Eisenberg, MD; Kristi M. Pado, MD; Faye Lee, RN
Arch Surg. 1997;132(8):886-891. doi:10.1001/archsurg.1997.01430320088014.
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Objectives:  To determine the success of unilateral exploration vs bilateral exploration for primary hyperparathyroidism and to analyze the validity of preoperative localization tests.

Design:  Case-control study of patients who underwent surgical exploration (unilateral, n=43; bilateral, n=57) by 1 surgeon from January 1991 through May 1996 and who had ultrasound examination of the neck and thallium-technetium scintigraphy performed before parathyroid surgery. Initially, unilateral exploration was used sparingly, but it became the standard approach in 1994 if localization was correct.

Setting:  Urban multispecialty clinic, teaching hospital.

Patients:  One hundred consecutive patients who underwent surgical exploration for primary hyperparathyroidism.

Interventions:  Ultrasonography of the neck, thalliumtechnetium scintigraphy, and parathyroidectomy.

Main Outcome Measures:  Imaging success, operative success, and operative time.

Results:  In 94 patients with solitary adenomas, the adenoma was demonstrated by ultrasound scans in 66%, by thallium-technetium scintigraphy in 83%, and by either test in 87%. Correct identification by ultrasonography was 59%; by thallium-technetium scintigraphy, 75%; and together, 73%. Of 6 patients with multiple-gland disease, 2 were correctly identified by localization tests and 9 of 15 abnormal glands were demonstrated. Of the 43 unilateral explorations, 43 single adenomas and no cases of multiple-gland disease were identified; of the 57 bilateral explorations, 51 single adenomas and 6 cases of multiple-gland disease were identified. No complications occurred in either group. Hypercalcemia persisted in 3 patients who underwent bilateral exploration and recurrent hypercalcemia developed in 1 patient in each group. The average operative time for the unilateral procedure was 105 minutes, and for the bilateral procedure, 184 minutes (P<.001). Since 1994, 31 (66%) of 47 patients have had unilateral exploration based on correct localization tests.

Conclusions:  Unilateral exploration that is based on the results of localization tests requires less operative time and produces results similar to bilateral exploration.Arch Surg. 1997;132:886-891


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