Surgery for primary hyperparathyroidism.
OBJECTIVE: To define the role of surgery for organic primary hyperparathyroidism and to evaluate the diagnostic and operative methods applied. DESIGN: Retrospective, non-randomized, non-blinded evaluation. Case series. SETTING: Tertiary referral center. Department of Surgery. SUBJECTS AND METHODS: The report documents experience in surgical management at a single institution of 312 patients with primary (and 498 patients with secondary) hyperparathyroidism in a period from 1974 to 2000. Patient symptoms, clinical features, diagnostic and localization methods, operative management, and postoperative results were evaluated by retrospective medical record review with special attention to surgical management strategy. RESULTS: Of 321 patients with primary hyperparathyroidism 312 underwent 348 operations. There were 312 primary procedures and 36 multiple reoperations on 25 patients. The permanent success rate for primary (312) operations was achieved in 287 patients (92%). The permanent success rate for 36 secondary reoperations was achieved in 19 out of 25 reoperated patients (76%). The overall full recovery was obtained in 306 operated patients (98%). There were no postoperative emergency reoperations. There were 2 postoperative hospital deaths (0.6%) of patients with sustained hypercalcemic crisis after excision one cervical adenoma, but functioning second one in mediastinum.