UNSUCCESSFUL
REOPERATION FOR PERSISTENT/RECURRENT PRIMARY HYPERPARATHYROIDISM
Unsuccessful
reoperation for persistent/recurrent primary hyperparathyroidism (R-P PHPT) is
a very disappointing experience for the surgeon, but also for the patient.
Experience in endocrine surgery from the part of the operating surgeon is of
crucial importance to minimize failure rates. Indeed, when reoperation is performed
by an experienced endocrine surgeon, failure rates are low (< 5 %) despite
the technical challenges and difficulties encountered during reoperation.
Failure in these cases is typically due to the presence of ectopic and/or
supernumerary parathyroid glands, potentially located within the mediastinum,
but not identified during preoperative investigation.
Before
attempting a new surgical intervention, accurate and reliable localization of
the remaining hyperfunctioning parathyroid parenchyma is mandatory to identify
the missing gland(-s), preferentially using noninvasive methods (typically Tc99m-sestamibi
scan, Magnetic Resonance Imaging [MRI], Computed Tomography [CT, preferentially
four- dimensional (4D) – CT, SPECT etc.). Occasionally invasive diagnostic
investigation (including arteriography and selective venous sampling) may be
required.
It should
be emphasized that these complex surgical procedures should be performed by
highly experienced endocrine surgeons, to avoid a new failure in treating PHPT.
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