Unilateral neck exploration for primary hyperparathyroidism
R. J. Lucas, R. J. Welsh and J. L. Glover
Department of Surgery, William Beaumont Hospital, Royal Oak, Mich. 48073.
The operative approach to primary hyperparathyroidism due to a single
adenoma remains controversial. We evaluated our experience with 75 patients
presenting with primary hyperparathyroidism between January 1979 and
September 1988. Prior to 1985 all patients underwent bilateral exploration.
During this period, ultrasonographic localization in 6 patients proved
highly accurate. Subsequently, routine preoperative ultrasonographic
localization was used and patients were prospectively evaluated for the
following: (1) incidence of unilateral exploration, (2) accuracy of
ultrasonographic localization, (3) incidence of complications, and (4)
operative time. Localization permitted unilateral exploration in 19 of 36
patients, although its accuracy depended on the interest of the radiologist
involved. Institution A had an accuracy of 92%, while institution B had an
accuracy of only 43%. There were fewer complications with unilateral
exploration, and operative time was significantly less. Unilateral
exploration based on preoperative ultrasonographic localization is
recommended as the initial approach to primary hyperparathyroidism due to a
single adenoma.
