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World Journal of Surgery

Published in:

01-11-2009

Remedial Operation for Primary Hyperparathyroidism

Authors: Jason D. Prescott, Robert Udelsman

Published in: World Journal of Surgery | Issue 11/2009

Abstract

Background

Remedial surgery for patients with persistent or recurrent primary hyperparathyroidism (1° HPT) remains a significant challenge. Cervical reexploration is technically difficult; reoperative neck anatomy is distorted by fibrosis and, as a result, remedial 1° HPT patients carry an increased risk of injury to the recurrent (RLN) and superior laryngeal nerve(s) as well as to normal residual parathyroid tissue. Causative hyperfunctioning parathyroid tissue is also more frequently ectopic in the remedial setting and can thus be difficult to localize.

Methods

This report assimilates the current data underlying preoperative, intraoperative and postoperative remedial 1° HPT management and presents an evidence-based algorithm for the management of remedial parathyroid disease. Recommendations are graded according to the quality of supporting data using the system initially developed by Sackett (Chest 95:2S–4S, 1989) and subsequently modified by Heinrich et al. (Ann Surg 243:154–168, 2006).

Results

Recent advances in preoperative localization and intraoperative adjuncts have lead to substantial improvements in outcomes after remedial surgery. Preoperative localization techniques, including sestamibi scintigraphy (MIBI), high resolution ultrasound (US), US-guided fine needle aspiration (FNA) and selective venous sampling (SVS), coupled with intraoperative adjuncts such as the rapid parathyroid hormone (PTH) assay have lead to reoperative cure rates as high as 96 percent. Nonetheless, management of remedial 1° HPT varies significantly between surgeons and no formal recommendations standardizing the care of these patients have been published.

Conclusions

Despite the significant challenges associated with remedial surgery for 1° HPT, excellent outcomes can be reproducibly achieved when proper pre-, intra-, and postoperative management is employed.

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Title: Remedial Operation for Primary Hyperparathyroidism
Authors: Jason D. Prescott
Robert Udelsman
Publication date: 01-11-2009
Publisher: Springer-Verlag
Published in: World Journal of Surgery / Issue 11/2009
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-009-9962-0

At a glance: The STEP trials

Springer Medicine

Remedial Operation for Primary Hyperparathyroidism

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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