Abstract
Background. Parathyroid surgery in patients with uremia and secondary hyperparathyroidism is
performed either by subtotal parathyroidectomy or total parathyroidectomy with immediate
reimplantation. The aim of this study was to compare the results of reoperation for
persistent or recurrent hyperparathyroidism after parathyroidectomy according to which
initial operative procedure was used. Patients and methods. Eighty-nine patients had reoperation for persistent (28 patients) or recurrent (61
patients) hyperparathyroidism after 53 subtotal parathyroidectomies and 36 total parathyroidectomies
with immediate reimplantation. Results of the reoperation were assessed in terms of
success rate, morbidity, and operative findings. Results. The success rate of reoperation in patients with persistent hyperparathyroidism was
89% and was independent of the initial type of surgery. Success rates of reoperation
for recurrent hyperparathyroidism after initial subtotal parathyroidectomy and total
parathyroidectomy with immediate reimplantation were 87% and 70%, respectively (P =.02). Hypertrophy of the parathyroid remnant was the main cause of recurrence after
subtotal parathyroidectomy. After total parathyroidectomy with immediate reimplantation,
recurrence was located in the graft in half the patients, while hyperplastic tissue
was found in the neck or the mediastinum in the other half. Conclusions. Subtotal parathyroidectomy provides the best conditions for successful reoperation
in case of recurrent hyperparathyroidism and should become the surgical treatment
of choice for secondary hyperparathyroidism. (Surgery 2000;127:562–5.)
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Article info
Publication history
Accepted:
January 12,
2000
Footnotes
*Reprint requests: Emile Sarfati, MD, Department of Surgery, Hôpital Saint Louis, 1 Ave Claude Vellefaux 75475, Paris, Cedex 10, France.
**Surgery 2000;127:562–5
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
