Unilateral exploration for primary hyperparathyroidism

To examine the efficacy of using pre-operative imaging studies (Sesta-MIBI scan and ultrasonography) to localize the pathology and allow for unilateral neck exploration to assess its safety.

Descriptive analytical study.

Department of Surgery/ENT, Pakistan Institute of Medical Sciences (PIMS), Islamabad.

Twenty-three patients were reviewed, who underwent operation for primary hyperparathyroidism (PHPT) in our institution between 1995 and 2002. A total of 49 enlarged parathyroid glands were removed. Patients were divided into two groups. In group-A (in which only unilateral exploration was done) there were 21 patients (42 glands). In group-B, bilateral exploration was done, which included 2 patients and 7 glands. Sesta-MIBI scan and ultrasonography were done in all cases. Results were analyzed statistically with appropriate tests of significance.

Sesta-MIBI scan showed an accuracy of 91% (20 adenomas) whereas ultrasound was positive in 18 patients (78%). One case of adenoma and 2 cases of hyperplasia were not detected by pre-operative imaging. Unilateral exploration of neck was successful in 19 cases of adenoma. The parameters used for successful exploration were corrected serum calcium and parathyroid hormone levels. Ultrasound was positive in 18 patients (78%). There was a significant difference in surgical time between the unilateral and bilateral neck explorations (45 minutes). Unilateral neck exploration for hyperparathyroidism has been successful in curing hypocalcaemia 22/23(95%).

At least two pre-operative localization tests, a Sesta-MIBI scan and ultrasonography, should be done for accurate localization of an abnormal parathyroid gland especially adenoma. Selective unilateral exploration is safe and reliable if the second ipsilateral gland is normal macroscopically or microscopically.