Initial parathyroid exploration: current trends in Australia.
BACKGROUND
An Australia-wide multicentre prospective study was undertaken to audit cases of initial parathyroid exploration between 1 January and 31 December 1992. One hundred and sixty-two cases were audited. The audit was designed to study pre-operative biochemical assessment, localization techniques and the technique of exploration.


METHODS
A pro forma audit form was circulated to all Australian surgeons known to perform parathyroid surgery. Eleven responded.


RESULTS
Free serum ionized calcium (iCa) was measured in 30% of cases, with the majority of pre-operative calcium assays being performed using total serum calcium (tCa). In 40 cases (29%) pre-operative localization techniques were used. These proved inaccurate in 10 cases. The intra-operative technique of localization with methylene blue infusion was used in 11% of cases. All four glands were biopsied in 11% of cases. No deaths were reported and a postoperative morbidity rate of 3.1% was noted. Eighty-eight per cent of patients were discharged within 5 days of surgery with a third going home within 48 h of neck exploration surgery. Only one patient (0.6%) required re-exploration for persistent hypercalcaemia due to a second adenoma.


CONCLUSIONS
The surgical treatment of hyperparathyroidism can be regarded as safe, with minimum morbidity in experienced hands. Pre-operative localization studies in initial parathyroid exploration are not indicated.
Sinha
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SN
Department of Surgery, University of Tasmania, Royal Hobart Hospital, Hobart, Australia.
Subramaniam
P
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000175:diagnosis* / Q000601:surgery*; D008297:Male; D008485:Medical Audit; D008875:Middle Aged; D010280:Parathyroid Glands / Q000473:pathology / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies