Parathyroid re-exploration.

Abstract

The authors evaluated their experience with 27 patients who required parathyroid re-explorations. The initial exploration was unsuccessful in 20 patients: in 8 because of ectopic lesions, in 2 because of undetected supernumerary glands, and in 10 because of inadequate exploration of the neck. All of the patients with inadequate neck explorations were found to have eutopic disease. Seven patients required re-exploration because of recurrent disease. Localization studies were performed prior to re-explorative surgery in 26 of 27 patients, which resulted in successful placement in 21. Invasive procedures, selective vein catheterization, and/or arteriography were effective in 12 of 15 patients. Noninvasive procedures, including thallium-technetium scintigraphy, magnetic resonance imaging, computed tomography, and ultrasonography, were accurate in 14 of 21 patients. Twenty-three (85%) of 27 patients were cured, including 17 of 20 patients after an unsuccessful initial exploration and 6 of 7 patients with recurrent disease. Careful review of operative and pathology reports from the initial surgery was essential in determining the adequacy of the exploration, the presence of microscopic abnormalities, and the glands that were positively identified. Such analysis, in conjunction with noninvasive localization studies, will lead to successful re-exploration in the majority of cases.