BACKGROUND: A subset of patients who are being maintained on dialysis
for end-stage renal disease develop severely symptomatic secondary hyp
erparathyroidism that cannot be controlled medically. The relative mer
its of two alternative surgical approaches-subtotal parathyroidectomy
versus total parathyroidectomy with autotransplantation-have not been
clearly elucidated. METHODS: The records of 77 patients who had renal
failure and underwent parathyroid surgery between 1982 and 1993 were r
etrospectively reviewed. RESULTS: Fifty-three patients (69%) underwent
subtotal parathyroidectomy and 24 (31%) underwent total resection wit
h autotransplantation into forearm musculature. The incidences of post
operative hypocalcemia and tetany were similar in both groups, as was
the recurrence rate (7%) of clinically significant hyperparathyroidism
. CONCLUSIONS: Subtotal parathyroidectomy can be performed without mor
tality or morbidity and provides good control of hyperparathyroidism s
econdary to chronic renal failure. Total parathyroidectomy with autotr
ansplantation offers no additional advantage in this difficult patient
population. Most patients will require postoperative intravenous calc
ium replacement. We observed a significant incidence of continued hype
rparathyroidism following successful renal transplantation.