Success rate of cervical exploration for hyperparathyroidism

In a three-year experience with 361 patients who underwent exploratory surgery for hyperparathyroidism, the success rate for primary cervical operations was 95% and that for secondary operations (cervical and mediastinal) was 62%; for all operations, it was 94%. The three most important factors in determining successful cervical exploration of the parathyroid glands are correct preoperative diagnosis, meticulous surgical technique, and accurate determination of abnormal locations of pathologic conditions. Ancillary studies or techniques for preoperative localization of parathyroid tissue were utilized in only a few patients who had unusually complicated problems. The results of this study suggest that, because of cost, time involvement, and potential risk, selective venous sampling with radioimmunoassay of parathyroid hormone or arteriography or both should be reserved for complicated problems and for patients being considered for a second or third exploratory operation.