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Reoperationen beim primären Hyperparathyreoidismus

Erfahrungen aus der Literatur und 106 eigenen Reoperationen

Reoperation for primary hyperparathyroidism

Experience gathered from the literature and 106 of our own reoperations

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Zusammenfassung

Die chirurgische Erstbehandlung des primären Hyperparathyreoidismus (pHPT) ist bei adäquater Expertise nahezu immer erfolgreich. Reoperationen sind eine besondere Herausforderung für den Chirurgen, ein hohes Risiko für den Patienten und seltener erfolgreich als Erstoperationen. In dieser Übersicht werden die Gründe für erfolglose Erstoperationen, die wichtigsten Punkte der Vorbereitung und Durchführung von Reoperationen und die dafür erforderlichen technischen und personellen Voraussetzungen diskutiert. Standardisiertes Vorgehen und entsprechende Erfahrung sowie zeitgemäße technische Ausstattung vorausgesetzt, ist bei Reoperationen beim pHPT häufiger als früher eine dauerhafte Beseitigung der Hyperkalzämie zu erreichen.

Neben der weiterhin uneingeschränkt gültigen Erkenntnis, dass der beste Schutz vor einer Reoperation und den sie begleitenden Komplikationen der durch die Kenntnisse des Operateurs erreichte Erfolg der ersten Operation ist, muss erneut unterstrichen werden, dass Reoperationen nur in Kliniken mit einer speziellen Expertise durchgeführt werden sollten.

Abstract

While the initial treatment for primary hyperparathyroidism (pHPT), if managed by an experienced surgeon, is almost always successful, reoperations are challenging. Patients are at high risk for complications and the rates of success are plainly below those of primary cervical explorations. In this paper the reasons for failure during initial procedures are reviewed, as are the most important localization procedures and the prerequisites with regard to technical infrastructure as well as personnel, when planning repeat operations for a missed parathyroid adenoma.

Provided that a standardized diagnostic and surgical approach is used, the surgeon is experienced, and up-to-date technical equipment is available, permanent normocalcemia following reoperations in pHPT is more frequently achieved than it used to be. The best option to avoid reoperations and associated complications is a successful initial intervention by an experienced surgeon. However, reoperations should always be performed by an experienced surgeon.

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  1. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Philipps-Universität Marburg

    E. Karakas, A. Zielke, C. Dietz & M. Rothmund

  2. Klinik für Visceral-, Thorax- und Gefäßchirurgie, Klinikum der Philipps-Universität, Baldingerstraße, 35043 Marburg

    E. Karakas

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  1. E. Karakas
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  2. A. Zielke
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  4. M. Rothmund
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Correspondence to E. Karakas.

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Karakas, E., Zielke, A., Dietz, C. et al. Reoperationen beim primären Hyperparathyreoidismus. Chirurg 76, 207–216 (2005). https://doi.org/10.1007/s00104-004-0994-6

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