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Revision parathyroid surgery – challenges and considerations in comparison to primary surgery

Published online by Cambridge University Press:  20 March 2023

A McClean Open the ORCID record for A McClean [Opens in a new window]  and
R J A England
A McClean*
Affiliation:
Plastic and Reconstructive Surgery, Hull University Teaching Hospitals NHS Trust, Hull, UK
R J A England
Affiliation:
ENT, Hull University Teaching Hospitals NHS Trust, Hull, UK
*
Corresponding author: Adam McClean; Email: adam.mcclean1@nhs.net
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Abstract

Objective

Revision parathyroidectomy is made necessary by recurrent or persistent parathyroid disease. This study aimed to identify challenges in revision surgery compared to primary parathyroid surgery.

Methods

All revision parathyroidectomies performed by one surgeon over a 17-year period were assessed for demographics, imaging, histology, biochemistry, cure rate, gland weight, gland location and gland ectopia, and compared to a series of 100 primary parathyroidectomies.

Results

Twenty-eight revision surgical procedures were identified. Sestamibi scanning for gland localisation was superior to ultrasound in both primary and revision surgery. Pre-operative calcium and gland weight were significantly higher in revision cases. There were no significant differences in post-operative calcium levels, pre- or post-operative parathyroid hormone levels, or gland location. 36 per cent of glands excised in revision surgery were ectopic, compared to 25 per cent in primary procedures. The cure rate was significantly lower in revision surgery.

Conclusion

Revision parathyroidectomy patients present with higher pre-operative calcium and larger adenomas; the cure rate is significantly lower in these patients.

Keywords

Parathyroid neoplasmsparathyroid diseasesparathyroid disordersrevision surgery
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 137 , Issue 11 , November 2023 , pp. 1233 - 1236
Copyright
Copyright © The Author(s), 2023. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Dr A McClean takes responsibility for the integrity of the content of the paper

Data presented in part at the British Association of Endocrine and Thyroid Surgeons Meeting, 7–8 October 2021, Leeds, UK.

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