CONSERVATIVE VERSUS LIBERAL APPROACH TO PARATHYROID NECK EXPLORATION

  • 1 January 1977
    • journal article
    • research article
    • Vol. 82  (4) , 466-473
Abstract
Is the recent trend toward more radical parathyroid surgery justified? Surgical outcomes in 3 groups of 50 patients undergoing operation for primary hyperparathyroidism at the Mayo Clinic [USA] between Jan., 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 1 normal-sized gland). A 2nd group was operated on by a Surgeon B, who used a more liberal approach (almost routine removal of at least 2 glands, removal of three and one-half glands when more than 1 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 3rd group of 50 patients was operated on by Surgeon B using the conservative approach. The incidence of postoperative hypocalcemia was reduced to 2%; 1 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).

This publication has 2 references indexed in Scilit: