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2010 Annual Meeting Abstracts

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Is Reoperation for Secondary Hyperparathyroidism Avoidable? - An Analysis of 161 Patients who Underwent Reoperative Parathyroidectomy
*Ralph Schneider, *Detlef K Bartsch, *Katja Schlosser
Philipps University Marburg, Marburg, Germany

Objective
The aim of this study was to evaluate preceding procedures and surgical findings of patients who underwent reoperative parathyroidectomy (PTX) for otherwise uncontrollable secondary hyperparathyroidism (sHPT).
Design
Analysis of a prospective database
Setting
Tertiary referral center
Patients
161 patients who underwent reoperative PTX between 1976 and 2010
Main Outcome Measures
Data were analyzed for the kind and number of preceding surgical procedures, perioperative calcium and PTH levels and postoperative outcome.
Results
66 patients necessitated an autograft resection (group A) due to a regrowth of the autograft as a consequence of persistent stimuli. 95 patients received a neck reexploration (group B). The reason for recurrent sHPT in this group was an incomplete initial PTX in 62 patients, supernumerary glands in 25 patients and a parathyromatosis in 8 patients. After reoperation, mean calcium dropped from 2.68 to 2.26mmol/l (A) and from 2.69 to 2.04mmol/l (B). PTH dropped from 1646.9 to 199.8pg/ml in group A and from 1263.5 to 128.8pg/ml in group B.
Mean follow-up was 55 months. Postoperative complications occurred in 6.1% (4/66) in group A and in 23.2% (22/95) in group B, including a rate of permanent recurrent laryngeal nerve palsies of 8.4% (8 of 95).
Conclusions
Reoperations at the neck for persistent or recurrent sHPT can be avoided when all parathyroid glands, including supernumerary ones, were resected at the time of initial neck exploration. Careful tissue preparation respecting the parathyroid gland capsule is a prerequisite to avoid parathyromatosis.
However, a regrowth of parathyroid autografts can only be hindered by adequate vitamin D substitution and consequent control of phosphatemia or by an abdication of the method itself.


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