 |
|
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.
Abstract
| |
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
Author Affiliations
From the Departments of Surgery (Mr Shen and Drs Düren, Duh, Siperstein, and Clark), Radiology (Dr Higgins), and Nuclear Medicine (Dr Morita), University of California—San Francisco/Mt Zion Medical Center, San Francisco, Calif, and Department of Veterans Affairs, San Francisco (Dr Duh). Dr Düren is now with the Medical Faculty, University of Istanbul, Turkey.
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Parathyroid Hormone Venous Sampling Before Reoperative Surgery in Renal Hyperparathyroidism: Comparison With Noninvasive Localization Procedures and Review of the Literature
Seehofer et al.
Arch Surg 2004;139:1331-1338.
ABSTRACT
| FULL TEXT
Modern Parathyroid Surgery: A Cost-benefit Analysis of Localizing Strategies
Fahy et al.
Arch Surg 2002;137:917-923.
ABSTRACT
| FULL TEXT
Long-term Management and Outcome of Parathyroidectomy for Sporadic Primary Multiple-Gland Disease
Rose et al.
Arch Surg 2001;136:621-626.
ABSTRACT
| FULL TEXT
Comparison between MR Imaging and
Gotway et al.
Radiology 2001;218:783-790.
ABSTRACT
| FULL TEXT
Relative Contributions of Technetium Tc 99m Sestamibi Scintigraphy, Intraoperative Gamma Probe Detection, and the Rapid Parathyroid Hormone Assay to the Surgical Management of Hyperparathyroidism
Dackiw et al.
Arch Surg 2000;135:550-557.
ABSTRACT
| FULL TEXT
Parathyroid Imaging with Tc-99m Sestamibi Planar and SPECT Scintigraphy
Nguyen
RadioGraphics 1999;19:601-614.
ABSTRACT
| FULL TEXT
Effect of Surgeon Expertise on the Outcome in Primary Hyperparathyroidism
Willeke et al.
Arch Surg 1998;133:1066-1070.
ABSTRACT
| FULL TEXT
Sestamibi Scanning Is Inadequate for Directing Unilateral Neck Exploration for First-Time Parathyroidectomy
Shen et al.
Arch Surg 1997;132:969-976.
ABSTRACT
|
