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Background. An assessment was made of operative risk and outcome after parathyroidectomy for
primary hyperparathyroidism.
Methods. A retrospective study was conducted in a single center university hospital in Switzerland.
The 173 patients (130 women and 43 men) ranged from 17 to 89 years of age (mean, 62.0
years). No routine preoperative localization methods were used for primary neck exploration.
Parathyroidectomy was performed under general anesthesia. No routine use was made
of intraoperative biopsy of glands whose macroscopic appearance was normal. The 173
patients underwent 179 operations (170 primary and 9 secondary interventions). Resection
of a single gland was performed in 127 cases (73.4%) and of two glands in 36 cases
(20.8%). Subtotal parathyroidectomy (3 1/2 glands) was performed in 10 cases (5.8%).
Results. Of 170 patients with primary intervention, 164 (96.5%) were normocalcemic after operation.
Six of 170 patients (3.5%) underwent early reexploration. Three additional patients
underwent late secondary procedures. These nine secondary operations were successful
in seven patients (78%). At follow-up (mean, 24.7 months after operation) normocalcemia
was noted in 163 of 171 patients (95.3%). Persistent and recurrent hyperparathyroidism
occurred in 1.2% and 3.5% of patients, respectively. Permanent postoperative hypoparathyroidism
was noted in 4% (six of seven patients underwent a subtotal parathyroidectomy for
multiglandular hyperplasia). Operative morbidity and mortality were 2.3% and 0.6%,
respectively.
Conclusions. Our surgical strategy for treatment of primary hyperparathyroidism has proved to
be safe with a favorable outcome in more than 95% of patients. This was possible without
the routine use of preoperative localization studies and intraoperative biopsy of
macroscopically normal glands. Routine biopsy of normal-appearing glands seems to
be unnecessary and may increase the risk of hypoparathyroidism.
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Article info
Publication history
Accepted:
August 29,
1994
Identification
Copyright
© 1995 Mosby-Year Book, Inc. Published by Elsevier Inc.
