Unilateral versus bilateral neck exploration in parathyroid surgery: an assessment of 55 cases

We retrospectively evaluated the cases of 55 patients who had undergone surgery for primary hyperparathyroidism at our institution to determine whether their parathyroid glands were abnormal on both sides. Thirty-six of these patients had undergone a bilateral neck exploration, and 19 had had a unilateral investigation. Of the 36 bilaterally explored patients, 30 had a solitary adenoma and no parathyroid pathology on the opposite side, five patients had hyperplastic glands with more than one gland involved, and one patient had two adenomas. In the unilaterally explored group, all 19 patients had a solitary adenoma. There were no failures in the way of persistent hypercalcemia in either group. Based on our findings, we conclude that a unilateral neck exploration should be performed during surgery for primary hyperparathyroidism whenever a large parathyroid adenoma and a normal parathyroid gland are found on the same side. Bilateral exploration should be reserved for patients in whom pathology cannot be found on the initially explored side during surgery and for patients who have obvious parathyroid hyperplasia.