PARATHYROIDECTOMY IN PRIMARY HYPERPARATHYROIDISM - PREOPERATIVE LOCALIZATION AND ROUTINE BIOPSY OF UNALTERED GLANDS ARE NOT NECESSARY

Background. An assessment was made of operative risk and outcome after parathyroidectomy for primary hyperparathyroidism. Methods. A retrosp ective study was conducted in a single center university hospital in S witzerland The 173 patients (130 women and 43 men) ranged from 17 to 8 9 years of age (mean, 62.0 years). No routine preoperative localizatio n methods were used for primary neck exploration. Parathyroidectomy wa s performed under general anesthesia. No routine use was made of intra operative biopsy of glands whose macroscopic appearance was normal. Th e 173 patients underwent 179 operations (170 primary and 9 secondary i nterventions). Resection of a single gland was performed in 127 cases (73.4%) and of two glands in 36 cases (20.8%). Subtotal parathyroidect omy (31/2 glands) was performed in 70 cases (5.8%). Results. Of 170 pa tients with primary intervention, 164 (96.5%) were normocalcemic after underwent early reexploration. Three additional patients underwent la te secondary procedures. These nine secondary operations were successf ul in seven patients (78%). At follow-up (mean, 24.7 months after oper ation) normocalcemia was noted in 163 of 171 patients (95.3%). Persist ent and recurrent hyperparathyroidism occurred in 1.2% and 3.5% of pat ients, respectively. Permanent postoperative hypoparathyroidism was no ted in 4% (six of Seven patients underwent a subtotal parathyroidectom y for multiglandular hyperplasia). Operative morbidity and mortality w ere 2.3% and 0.6%, respectively. Conclusions. Our surgical strategy pr treatment of primary hyperparathyroidism has proved to be safe with a favorable outcome in more than 95% of patients. This was possible wit hout the routine use of preoperative localization studies and intraope rative biopsy of macroscopically normal glands. Routine biopsy of norm al-appearing glands seems to be unnecessary and may increase the risk of hypoparathyroidism.