SUCCESS OF UNILATERAL NECK EXPLORATION FOR SPORADIC PRIMARY HYPERPARATHYROIDISM

Background Unilateral neck exploration fir primary hyperparathyroidism (PHPTH) is controversial because of concern about missed multiglandul ar disease. Methods. In patients with sporadic PHPTH our approach has been arbitrarily to surgically explore the right neck first unless pre operative or intraoperative evidence suggests left-sided parathyroid p athologic condition. When an adenoma is identified and a normal ipsila teral gland is confirmed on histologic examination, the contralateral side is not explored. A 15-year series of 371 patients with sporadic P HPTH was reviewed retrospectively to determine the efficacy of this st rategy. Results. At operation unilateral exploration was possible in 1 25 patients (34%). Of these 122 had a single adenoma and two patients had parathyroid, carcinoma. One patient with unrecognized hyperplasia required subsequent subtotal parathyroidectomy. There were no major co mplications. Bilateral surgical exploration was required in 246 patien ts including 18 with hyperplasia, 4 with double adenomas, and 4 with p arathyroid cancer. Bilateral surgical exploration failed in 18 patient s (14 persistent and 4 recurrent PHPTH) and was complicated by one rec urrent nerve palsy and two cases of permanent hypocalcemia. Operative time was significantly shorter in the unilaterally explored group. Con clusions. When possible, unilateral exploration fir PHPTH is safe and effective, avoids obliterative scarring of the contralateral neck, and may reduce morbidity and operative time.