UNILATERAL PARATHYROID EXPLORATION

Unilateral neck exploration (UNE) for primary hyperparathyroidism can be done with the same excellent results as bilateral neck exploration (BNE) with decreased operative time and post operative complications w ith a good pre operative localization study. One hundred six charts we re reviewed retrospectively in patients operated on between May 1989 a nd October 1996 with primary hyperparathyroidism. Seventy-seven of the se patients had preoperative ultrasounds (US) performed by a radiologi st interested in parathyroid ultrasonography. UNE was performed if the operative findings were consistent with the US and a normal gland was identified on the same side. If a normal gland was not identified on the initial side or there was a question of hyperplasia a BNE was perf ormed. Forty-six of the 77 patients had UNE, and 31 had BNE. Sixty-nin e of these patients were found to have accurate US. Based on these res ults there is a 90 per cent accuracy rate for US performed by an inter ested radiologist, Comparing operative times between patients with UNE and BNE, there was a statistical difference (P = 0,001). Complication s were also recorded in each group. Patients with UNE had a 22 per cen t complication rate, whereas patients with BNE had a 45 per cent compl ication rate. This difference was statistically significant (P = 0.04) (Fisher's exact test). The majority of complications were asymptomati c and symptomatic hypocalcemia. Two patients in the BNE group experien ced transient hoarseness. The advantages of UNE include reduced morbid ity, decreased operative time and avoidance of scarring in the contral ateral neck. In the total study population (n = 106), 99 patients (93. 4%) had a single adenoma. An accurate, noninvasive, low-cost preoperat ive localization study is necessary to practice UNE for primary hyperp arathyroidism. Parathyroid US, done by an interested radiologist, with a 90 per cent accuracy rate, meets all these criteria.