Surgical Techniques and Pearls: The Unsuccessful Reoperation

Abstract

Even in the most skilled of hands, a small percentage of patients will not be cured after reoperative parathyroid surgery. Reoperative parathyroid surgery can be dangerous even for the most experienced surgeons and is associated with higher complication rates. Damage to the recurrent laryngeal nerve (RLN), hypoparathyroidism, and persistent hyperparathyroidism are the common complications associated with reoperative parathyroid surgery [1]. Reoperative parathyroid surgery is often indicated for persistent primary hyperparathyroidism and recurrent primary hyperparathyroidism. Persistent primary hyperparathyroidism is defined as a failure of serum calcium and parathyroid hormone (PTH) normalization after a parathyroidectomy operation. Recurrent primary hyperparathyroidism occurs when serum calcium and PTH levels are initially normal but become elevated 6 months after surgery [2]. This is common in patients who have undergone a subtotal parathyroidectomy without correction of the underlying abnormality, such as renal disease. This represents a separate entity and will not be considered an unsuccessful operation.