Pre-operative ultrasonography guiding minimal, selective surgical approachin primary hyperparathyroidism

Background: The traditional surgical approach for the treatment of primary hyperparathyroidism (HPT) has been routine bilateral surgical exploration. Our aim was to evaluate pre-operative ultrasonography (U/S) in altering our practice to selective unilateral neck exploration. Patients and Methods: A retrospective study was conducted involving 53 pati ents who had parathyroidectomy over a 5-year period (1989-1994), 41 of whom with the diagnosis of HPT had pre-operative neck U/S. Results: Thirty-eight patients had a single adenoma, one had parathyroid ca ncer, and two had multiple adenomas. Thirty-six of 41 (88%) patients were t rue positives, two (5%) false positives, two (5%) false negatives and one ( 2%) was true negative. Based on the surgeon's personal preference and U/S r esults, 21/41 (51%) of patients had bilateral and 20/41 (49%) had unilatera l neck exploration. All the 41 patients had resolution of the hypercalcemia postoperatively. Eighteen of 38 (47%) patients with a single adenoma had b ilateral neck exploration and only in two patients was this necessary. Conclusions: Patients undergoing parathyroid surgery for HPT should have pr eoperative U/S and, if a single enlarged parathyroid gland is found, unilat eral U/S guided neck exploration is safe and economical. In all the other p atients, bilateral exploration is the preferred approach.