Reoperative parathyroid surgery for persistent hyperparathyroidism.

Abstract

In a 2-year period 30 patients with persistent hyperparathyroidism following 59 prior unsuccessful procedures underwent reoperation. Preoperative arteriography was useful in planning the surgical approach in 56%, and retrospectively was correct in 63%. Selective venous catheterization gave localizing information in 83%, correctly predicting site or side in 60% of the total. Computerized axial tomography was helpful in identifying mediastinal glands before operation. Reoperation was successful in rendering the patient hypocalcemic or normocalcemic in 83%. Of the 11 patients (37%) who were rendered profoundly hypocalcemic, two were subsequently weaned from vitamin D and calcium support; seven have received either fresh or cryopreserved parathyroid autografts. Persistent hyperparathyroidism is a difficult surgical problem which we believe warrants aggressive localization attempts prior to operation. Autotransplantation with cryopreserved parathyroid tissue may be of value in the long-term management of the high incidence of postoperative hypocalcemia in this patient group.

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@article{Brennan1978ReoperativePS, title={Reoperative parathyroid surgery for persistent hyperparathyroidism.}, author={Murray F. Brennan and John L. Doppman and Stephen J . Marx and Alien M. Spiegel and Edward Brown and Gerald D. Aurbach}, journal={Surgery}, year={1978}, volume={83 6}, pages={669-76} }