Abstract
Re-operative parathyroid surgery can result from prior parathyroid surgery or proximate neck surgeries. When a patient remains hypercalcemic and hyperparathyroid within 6 months following initial parathyroid surgery, he or she is considered to have persistent primary hyperparathyroidism. Recurrent primary hyperparathyroidism may occur after initial successful parathyroidectomy and postoperative period of normocalcemia. Over time, less invasive surgical techniques coupled with preoperative localization studies have shifted many initial operations away from initial four-gland exploration. Prior to embarking on re-operative parathyroid surgery, the surgeon should (1) review the prior and current biochemical workup to confirm the diagnosis, and (2) review the prior operative, pathology, imaging, and intraoperative PTH results in attempt to understand the extent of original surgery and potential cause for failure. Parathyroid embryology and anatomy, intraoperative PTH monitoring, preoperative imaging, radiopharmaceutical guidance, jugular venous sampling, and RLN monitoring are all important considerations and adjuncts which may be helpful in re-operative parathyroid surgery. Re-operative parathyroid surgery requires a systematic approach as the chance of cure in re-operative surgery is reduced and the chance of complication is increased in comparison to primary surgery. It is incumbent on the surgeon to optimize chances of success utilizing available localization techniques, and by exercising careful, calculated clinical judgement.
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Mark, J., Steward, D. (2017). Re-operative Parathyroid Surgery. In: Stack, Jr., B., Bodenner, D. (eds) Medical and Surgical Treatment of Parathyroid Diseases. Springer, Cham. https://doi.org/10.1007/978-3-319-26794-4_24
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DOI: https://doi.org/10.1007/978-3-319-26794-4_24
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