Results of reoperations for persistent or recurrent secondary hyperparathyroidism in hemodialysis patients

Abstract

Among 258 patients operated on for secondary hyperparathyroidism (HPT II) from 1971 to 1988, a total of 33 had one or more reoperations for persistent or recurrent HPT II. These reoperations did not induce any mortality or significant morbidity. After inadequate parathyroidectomy (25 cases), 15 patients were reoperated. Twelve of these had undergone initial surgery at another institution. Three patients died of causes unrelated to their HPT II. The other 12 patients are disease-free. After successful subtotal parathyroidectomy (79 cases), 2 patients (2.5%) had a recurrence 5 and 6 years later, respectively. Currently, the 2 patients remain disease-free. After total parathyroidectomy with autotransplantation (152 cases), 16 patients (10.5%) had reoperations on the grafts. The mean time before reoperation was 2 1/2 years. Hypertrophy of grafted fragments was observed in 4 cases (2.6%), but only 2 of these 4 patients were cured by removal of the grafts. Residual parathyroid tissue or a supernumerary gland in the neck or the mediastinum was suspected in 5 patients, but this could not be confirmed because one had already been reoperated on in the neck without success, another still refuses reoperation, and 3 died. In 6 other patients, the recurrence was debatable and HPT II was not confirmed. In the last 3 patients, the diagnosis was incorrect and aluminum intoxication was proved later. Results of reoperations for persistent or recurrent HPT II depend, first, on a correct diagnosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

“…Most centers perform either subtotal [12] or tPTX with autotransplantation [13,14,15] to avoid a possible hypoparathyroidism and the need for long-term calcium and vitamin D supplementation. Recurrence of hyperparathyroidism varies from 5 to 80% in different studies for the first two surgical approaches [12, 13,16,17,18,19,20,21]. To minimize the risk for recurrence as well as the number of surgical interventions, and because we fear severe relapses with calciphylaxis, we perform tPTX without autotransplantation [6].…”

Tratamiento quirúrgico del hiperparatiroidismo asociado a insuficiencia renal crónica: Experience in 71 patients

“…En la literatura se han evidenciado tasas de curación similares en pacientes tratados con PT con autoinjerto antebraquial y aquellos manejados con PP 20,21 . Con tasa de recurrencia entre el 10,5% al 80% y de 2,5% al 92% para pacientes con HPT renal tratados con PT con autoinjerto antebraquial y PP respectivamente 22,23 . No existiendo estudios clínicos aleatorizados que comparen ambas opciones de tratamiento.…”

Is three-gland-or-less parathyroidectomy a clinical failure for secondary hyperparathyroidism?

“…Twenty-six were male and 16 were female. Median age of the patients was 46 [21-75], and median preoperative dialysis duration was 9 [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Forty (95%) patients had at least one symptom as the indication for surgery, whereas only 2 (5%) patients were asymptomatic but biochemical findings were the indication (Table 1). Thirty-three (79%) patients had 3 or more symptoms (Table 2).…”

“…For this reason, removal of thymic tissue is commonly recommended to diminish persistence and recurrence (5). By definition, persistence and recurrence are commonly determined by biochemical findings but not physical (9)(10)(11). In the literature, data in regard to the course of complaints and physical findings are scarce in this group of patients.…”