Long-term follow-up after subtotal parathyroidectomy in patients with renal failure

Objectives/Hypothesis: The most appropriate type of surgery for hyperparath yroidism secondary to renal failure remains controversial. We report a 8-ye ar experience of patients with hyperparathyroidism secondary to end-stage r enal disease who underwent subtotal parathyroidectomy, We believe that this is the procedure of choice, offering several advantages over total parathy roidectomy with and without reimplantation. Study Design: Retrospective rev iew. Methods: Review of 14 consecutive renal failure patients who underwent subtotal parathyroidectomy by one surgeon (A.K.) was performed. Follow-up ranged from 4 to 54 months, All patients were receiving chronic maintenance dialysis. All patients came to surgery with clinical symptoms of parathyro id bone disease, elevated serum calcium levels (10.1-12.4 mg/dL), and intac t parathyroid hormone levels (619-4160 pg/mL), despite maximal medical ther apy, At exploration four glands were identified in all patients and three a nd a half mere removed. Results: All patients experienced symptomatic relie f postoperatively with normalization or near-normalization of serum calcium concentration and intact parathyroid hormone concentrations. One patient d eveloped recurrent disease 4 months after surgery, and on re-exploration a supernumerary substernal gland was identified. A second patient developed r ecurrent symptoms 4 years after surgery and at the time of this writing was awaiting re exploration. Conclusions: All patients had either resolution o f or marked improvement in their subjective complaints. There have been no cases of permanent hypoparathyroidism. We believe that subtotal parathyroid ectomy is the best procedure for patients with refractory symptoms of secon dary hyperparathyroidism.