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Abstract
Is the recent trend toward more radical parathyroid surgery justified? Surgical outcomes
in three groups of 50 patients undergoing operation for primary hyperparathyroidism
at the Mayo Clinic between January, 1974, and May, 1976, were compared. One group
of patients was operated on by Surgeon A who used a “conservative” approach (removal
of grossly enlarged glands only, with or without biopsy of one normal-sized gland).
A second group was operated on by a Surgeon B, who used a more “liberal” approach
(almost routine removal of at least two glands, removal of three and one-half glands
when more than one gland was enlarged, and liberal use of biopsy identification).
Symptomatic hypocalcemia requiring treatment occurred in 24% of patients after liberal
neck exploration, as compared with 4% in the conservatively treated group. The liberal
approach did not yield any higher cure rate. A third group of 50 patients was operated
on by Surgeon B using the conservative approach. The incidence of postoperative hypocalcemia
was reduced to 2%; one patient remained hypercalcemic. Symptomatic hypocalcemia, even
if temporary, represents significant morbidity. A conservative approach to neck exploration
in patients with primary hyperparathyroidism is recommended because it is associated
with a very low incidence of temporary postoperative hypoparathyroidism (2 to 4%)
and a high cure rate (99% in this series).
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Article info
Footnotes
☆Presented at the Thirty-fourth Annual Meeting of the Central Surgical Association, Buffalo, N. Y., March 3–5, 1977.
Identification
Copyright
© 1977 Published by Elsevier Inc.
