Strategy in reoperative surgery for hyperparathyroidism
P. S. Cheung, A. Borgstrom and N. W. Thompson
Division of Endocrine Surgery, University of Michigan Medical Center, Ann Arbor.
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.
