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June 1989

Strategy in Reoperative Surgery for Hyperparathyroidism

Author Affiliations

From the Division of Endocrine Surgery, University of Michigan Medical Center, Ann Arbor. Dr Cheung is now with the Department of Surgery, University of Hong Kong, Queen Mary Hospital.

Arch Surg. 1989;124(6):676-680. doi:10.1001/archsurg.1989.01410060038008

• Eighty-three patients undergoing reoperations for hyperparathyroidism were studied. Preoperative diagnosis was reviewed, and localization was employed in selected patients. Cervical reexploration was carried out in a systematic manner, and mediastinotomy was required in 11 patients. Sixty patients had had previous parathyroid exploration. Missed adenomas were found in 34, of which 28 were single and 6 were double adenomas. Fourteen single adenomas were in normal locations and 14 were in ectopic locations. Seventeen patients had hyperplasia; 6 were wrongly diagnosed as adenoma, 3 had inadequate excision, 2 had supernumerary glands, and 6 had remnant hypertrophy. Three patients had recurrent carcinoma. Two had wrong diagnoses and 4 had uncertain diagnoses. Reoperation eliminated hypercalcemia in 71 patients (85.5%). Eight patients developed permanent hypoparathyroidism, and 1 had a permanent recurrent nerve palsy. Reoperative parathyroid surgery can be minimized with thorough initial cervical exploration, correct pathologic interpretation, and adequate parathyroid resection.

(Arch Surg. 1989;124:676-680)

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