MORBIDITY ASSOCIATED WITH CONCOMITANT SUR GICAL-PROCEDURES IN PATIENTS UNDERGOING CERVICAL EXPLORATION FOR PRIMARY HYPERPARATHYROIDISM - RESULTS OF A PROSPECTIVE-STUDY

A prospective follow-up study was undertaken in patients undergoing su rgical therapy for primary hyperparathyroidism to establish the freque ncy of concomitant surgical procedures and their influence on the morb idity of cervical exploration. From 1 August 1987 to 15 October 1995, 231 patients underwent cervical exploration for primary hyperparathyro idism. In 16 patients 18 (7.8 %) concomitant abdominal and thoracic su rgical procedures as well as surgical interventions for soft-tissue tu mors were performed. A total of 133 patients (57.6 %) underwent thyroi d resections of varying extent; 4.8 % had carcinoma of the thyroid. Ca tamnestic data were obtained on the basis of a standardized follow-up in 94.4 % of all patients (1-9 follow-up examinations in 216 patients) . Hematoma occurred after adrenalectomy in a patient undergoing a conc omitant extracervical procedure. In patients with a first manifestatio n of primary hyperparathyroidism due to a solitary parathyroid adenoma (n = 189), an increase in the morbidity of parathyroid surgery perfor med in combination with a thyroid resection was observed. Furthermore, a relationship was established between the number of intraoperatively identified parathyroid glands and the incidence of permanent hypopara thyroidism (permanent hypoparathyroidism: initial cervical interventio n with parathyroid exploration alone, 2.2 %; with concomitant thyroid resection, 6.5 %; after secondary thyroid resection and parathyroid ex ploration alone, 0 %; after concomitant thyroid resection, 28.6 %; fou r parathyroid glands identified intraoperatively, 3.1 %; fewer than fo ur parathyroid glands identified, 8.2 %). The increase in the morbidit y of parathyroid surgery in combination with thyroid resection is just ifiable, because unsuspected thyroid carcinomas can potentially be tre ated curatively.