Reoperation for renal hyperparathyroidism

Yatsuka Hibi, Yoshihiro Tominaga, Tetsuhiko Sato, Akio Katayama, Toshihito Haba, Kazuharu Uchida, Toshihiro Ichimori, Masahiro Numano, Yuji Tanaka, Hiroshi Takagi, Tsuneo Imai, Hiroomi Funahashi, Akimasa Nakao

Research output: Contribution to journalArticle

29 Citations (Scopus)

Abstract

Reoperation for secondary hyperparathyroidism (HPT) due to uremia (2HPT) may be required among patients with persistent renal failure if not all parathyroid glands are removed at the initial operation. Between March 1981 and July 2001, altogether 1110 patients underwent total parathyroidectomy with forearm autograft for advanced 2HPT in our department. In this study, we evaluated the clinical features of patients who required reoperation and classified them into persistent HPT [the lowest intact parathyroid (PTH) level after initial operation remained higher than 60 pg/ml] and recurrent HPT (the lowest intact PTH level was normalized after surgery but reelevated became high enough to require reoperation). Removal of residual glands was indicated in 30 (2.7%) cases for persistent or recurrent HPT. All remaining glands were detected by preoperative imaging diagnoses. In 44 (4.0%) patients persistent HPT was recognized and in 15 of them (1.4% of all cases) reoperation was required. In 11 cases, the responsible glands were supernumerary ones removed from the mediastinum. In 4 cases, the glands were resected from the neck. In 15 cases (1.4%), reoperation was performed for recurrent HPT when residual glands were left either in the neck or in the thymic tongue. In all but one case, the missed glands were supernumerary. This study reveals that it is often difficult to avoid persistent HPT induced by mediastinal supernumerary glands and recurrent HPT caused by small glands left in the neck. Our findings indicate that patients with uremia should be closely followed considering the possibility that persistent or recurrent HPT may occur after parathyroidectomy.

Original languageEnglish
Pages (from-to)1301-1307
Number of pages7
JournalWorld Journal of Surgery
Volume26
Issue number10
DOIs
Publication statusPublished - 01-10-2002
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Surgery

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    Hibi, Y., Tominaga, Y., Sato, T., Katayama, A., Haba, T., Uchida, K., Ichimori, T., Numano, M., Tanaka, Y., Takagi, H., Imai, T., Funahashi, H., & Nakao, A. (2002). Reoperation for renal hyperparathyroidism. World Journal of Surgery, 26(10), 1301-1307. https://doi.org/10.1007/s00268-002-6731-8