RT Journal
A1 Cheung PY, Borgstrom A, Thompson NW
T1 STrategy in reoperative surgery for hyperparathyroidism
JF Archives of Surgery
JO Archives of Surgery
YR 1989
FD June 1
VO 124
IS 6
SP 676
OP 680
DO 10.1001/archsurg.1989.01410060038008
UL http://dx.doi.org/10.1001/archsurg.1989.01410060038008
AB • Eighty-three patients undergoing reoperations for hyperparathyroidism were studied. Preoperative diagnosis was reviewed, and localization was employed in selected patients. Cervical reexploration was carried out in a systematic manner, and mediastinotomy was required in 11 patients. Sixty patients had had previous parathyroid exploration. Missed adenomas were found in 34, of which 28 were single and 6 were double adenomas. Fourteen single adenomas were in normal locations and 14 were in ectopic locations. Seventeen patients had hyperplasia; 6 were wrongly diagnosed as adenoma, 3 had inadequate excision, 2 had supernumerary glands, and 6 had remnant hypertrophy. Three patients had recurrent carcinoma. Two had wrong diagnoses and 4 had uncertain diagnoses. Reoperation eliminated hypercalcemia in 71 patients (85.5%). Eight patients developed permanent hypoparathyroidism, and 1 had a permanent recurrent nerve palsy. Reoperative parathyroid surgery can be minimized with thorough initial cervical exploration, correct pathologic interpretation, and adequate parathyroid resection.(Arch Surg. 1989;124:676-680)