alexa Reoperative parathyroidectomy in 228 patients during the era of minimal-access surgery and intraoperative parathyroid hormone monitoring.


Journal of Surgery

Author(s): Richards ML, Thompson GB, Farley DR, Grant CS

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Abstract BACKGROUND: Reoperative parathyroidectomy (R-PTX) in primary hyperparathyroidism (1HPT) has increased failure rates and morbidity. This study evaluated R-PTX during the era of minimal-access PTX with intraoperative parathyroid hormone (IOPTH) monitoring. METHODS: Two thousand sixty-five patients with 1HPT who underwent PTX were assessed for R-PTX. Preoperative studies, operative findings, and outcomes were evaluated. RESULTS: Two hundred twenty-eight patients underwent 236 R-PTX procedures. Imaging performed included sestamibi (89\%), ultrasound (US; 56\%), computed axial tomography/magnetic resonance imaging (5\%), and selective venous sampling (1\%). Sestamibi was more sensitive than US (84\% vs 68\%). Curative surgery was performed in 89\% of patients. IOPTH was 99\% sensitive. There was no relationship between cure and the following parameters: preoperative calcium or PTH levels, persistent or recurrent disease, or use of IOPTH. Solitary gland disease and a single previous operation were associated with increased likelihood of cure (P = .06). Hypoparathyroidism was decreased using IOPTH monitoring (2\% vs 9\%). One patient had recurrent laryngeal nerve palsy. CONCLUSIONS: R-PTX can be performed effectively with minimal complications. IOPTH is an accurate predictor of cure and may decrease the frequency of permanent hypoparathyroidism. This article was published in Am J Surg and referenced in Journal of Surgery

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