EFFICACY OF SELECTIVE UNILATERAL EXPLORATION IN HYPERPARATHYROIDISM BASED ON LOCALIZATION TESTS

Objectives: To determine the success of unilateral exploration vs bila teral exploration for primary hyperparathyroidism and to analyze the v alidity of preoperative localization tests. Design: Case-control study of patients who underwent surgical exploration (unilateral, n=43; bil ateral, n=57) by 1 surgeon from January 1991 through May 1996 and who had ultrasound examination of the neck and thallium-technetium scintig raphy performed before parathyroid surgery. Initially, unilateral expl oration was used sparingly, but it became the standard approach in 199 4 if localization was correct. Setting: Urban multispecialty clinic, t eaching hospital. Patients: One hundred consecutive patients who under went surgical exploration for primary hyperparathyroidism. Interventio ns: Ultrasonography of the neck, thallium-technetium scintigraphy, and parathyroidectomy. Main Outcome Measures: Imaging success, operative success, and operative time.Results: In 94 patients with solitary aden omas, the adenoma was demonstrated by ultrasound scans in 66%, by thal lium-technetium scintigraphy in 83%, and by either test in 87%. Correc t identification by ultrasonography was 59%; by thallium-technetium sc intigraphy, 75%; and together, 73%. Of 6 patients with multiple-gland disease, 2 were correctly identified by localization tests and 9 of 15 abnormal glands were demonstrated. Of the 43 unilateral explorations, 43 single adenomas and no cases of multiple-gland disease were identi fied; of the 57 bilateral explorations, 51 single adenomas and 6 cases of multiple-gland disease were identified. No complications occurred in either group. Hypercalcemia persisted in 3 patients who underwent b ilateral exploration and recurrent hypercalcemia developed in 1 patien t in each group. The average operative time for the unilateral procedu re was 105 minutes, and for the bilateral procedure, 184 minutes (P<.0 01). Since 1994, 31 (66%) of 47 patients have had unilateral explorati on based on correct localization tests. Conclusions: Unilateral explor ation that is based on the results of localization tests requires less operative time and produces results similar to bilateral exploration.