Long-term outcome of unilateral parathyroid exploration for primary hyperparathyroidism due to presumed solitary adenoma

Unilateral cervical exploration for primary hyperparathyroidism (PHPT) remains controversial. Critics of unilateral exploration have argued that this surgical strategy results in an unacceptably large number of patients with persistent or recurrent hypercalcemia following the initial operation due to undetected additional parathyroid pathology on the contralateral, unexplored side of the neck. We have reviewed retrospectively a large cohort of patients who were submitted to scan-directed unilateral cervical exploration for PHPT following dual-isotope subtraction scintigraphy and according to a standard protocol. Between January 1, 1985 and June 30, 1999 a series of 184 patients underwent scan-directed unilateral neck exploration for PHPT. Following the initial operation three individuals (1.6%) demonstrated persistent hypercalcemia. At a mean follow-up of 59 months (range 6-168 months) none of the patients had developed recurrent hypercalcemia. Scan-directed unilateral cervical exploration represents a valid surgical strategy for a significant proportion of patients with PHPT; and in this group of patients it does not lead to an increased incidence of persistent or recurrent hypercalcemia.