[Surgical treatment of recurrent secondary hyperparathyroidism].
BACKGROUND
Secondary renal hyperparathyroidism (SHPT) affects nearly all patients on regular hemodialysis. Between 5% and 10% will need surgery to control the disease. Despite a meticulous technique, the rate of recurrent/persistent hyperparathyroidism after surgery remains between 2% and 12%.


METHODS
We reviewed the reoperations of 7 patients with recurrent or persistent SHPT from a series of 56 patients, 3 of which were referred from other units for treatment of recurrence. Subtotal parathyroidectomy (ST-PTX) was performed in 51 patients and total parathyroidectomy with autograft (TPTX-AT) was performed in the remaining 5 patients.


RESULTS
Seven patients underwent reoperation for recurrent SHPT, 1 of them twice (8 reinterventions in 56 patients). In 2 patients only 3 parathyroid glands were removed at the first intervention and recurrence was due to the presence of a fourth gland. In 4 patients, ST-PTX was performed and recurrence was due to a remnant hyperplasic area in 1 and to a fifth gland in 3. Recurrence in the patient with a TPTX-AT was to due to cervical parathyromatosis. All the patients with recurrence had a positive preoperative Tc-MIBI scintigraphy and the computed tomography/magnetic resonance examination was highly useful for anatomical localization of the lesion and for planning the surgical approach.
Jimeno
Jaime
J
Departamento de Cirugía, Hospital del Mar, Barcelona, Spain.
Pérez
Marta
M
Pereira
José A
JA
Sancho
Juan J
JJ
Sitges-Serra
Antonio
A
D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016105:Parathyroidectomy / Q000379:methods; D011877:Radionuclide Imaging; D012008:Recurrence; D012189:Retrospective Studies