Clinical analysis of reoperation for secondary hyperparathyroidism

Abstract

Objective: To investigate the safety and efficacy for reoperation after parathyroidectomy for persistent and recurrent secondary hyperparathyroidism (HPT). Methods: Totally 10 patients with persistent or recurrent HPT who underwent parathyroidectomy reoperation at Department of General Surgery, China-Japan Friendship Hospital from April 2001 to October 2012 were selected. Among them, 6 were male and 4 were female with age of (46.9±7.7) years (range: 36 to 57 years). There were 8 cases of persistent HPT and 4 cases of recurrent HPT. The general health condition, symptom changes, gland excision and transplantation records, pathological reports and intact parathyroid hormone (iPTH), serum calcium, phosphorus and alkaline phosphatase values of pre-operation, post-operation and during follow-up were collected and the causes of operation failure were analyzed. The efficacy was determined according to postoperative symptom improvement, iPTH values, perioperative mortality and postoperative complications. Results: Of the 10 patients, 8 cases underwent reoperation once (including 7 cases of neck exploration, 1 case of forearm exploration), and 2 cases underwent reoperation twice (all neck explorations). No postoperative death was reported. The laryngeal nerve damage occurred in 2 cases during reoperation, and it was gradually recovered 3 months after surgery with the vocal cord movement recovery after 2 years. Hypocalcemia occurred in all 10 cases after operation, and was effectively controlled with calcium supplement treatment. No complications such as the trachea and esophagus damage, and the neck hematoma were observed. The significant efficacy was demonstrated in 6 patients received 1 reoperation and 2 patients with 2 reoperations. Conclusion: Reoperation is a safe and effective treatment for the persistent or recurrent secondary HPT caused by end-stage renal disease after surgery.