Reoperative parathyroid surgery for persistent hyperparathyroidism.
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.
D000236:Adenoma / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D002648:Child; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis / Q000601:surgery*; D006996:Hypocalcemia / Q000628:therapy; D008297:Male; D008482:Mediastinum / Q000000981:diagnostic imaging; D008875:Middle Aged; D010280:Parathyroid Glands / Q000601:surgery* / Q000637:transplantation; D010282:Parathyroid Neoplasms / Q000601:surgery*; D010690:Phlebography; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous