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A 20-year study on 190 patients with primary hyperparathyroidism in a developing country: Turkey experience
Arif Usta1, Etem Alhan, Akif Cinel
11 Department of Surgery, State Hospital, Karabük, Turkey.
International Surgery
|April 16, 2015
Summary
This study of 190 primary hyperparathyroidism patients found focused unilateral neck exploration (FUNE) for parathyroidectomy is safe and effective. Experienced surgeons using FUNE achieve high success rates with shorter operation times and hospital stays.
Area of Science:
- Endocrinology
- Surgical Oncology
- Medical Imaging
Background:
- Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
- Diagnosis often involves elevated serum calcium and parathyroid hormone (PTH).
- Surgical management, parathyroidectomy, is the definitive treatment.
Purpose of the Study:
- To review a 20-year experience with parathyroidectomy for PHPT.
- To evaluate the effectiveness of imaging techniques and surgical approaches.
- To assess outcomes of focused unilateral neck exploration (FUNE) versus bilateral neck exploration (BNE).
Main Methods:
- Retrospective review of 190 PHPT patients undergoing parathyroidectomy.
- Analysis of diagnostic imaging: Ultrasonography (USG), Technetium-99m sestamibi scintigraphy (MIBI), and MRI.
- Comparison of FUNE and BNE surgical outcomes, including conversion rates, operation time, and hospital stay.
Main Results:
- 137 patients (72%) were asymptomatic at diagnosis.
- Mean serum calcium: 11.9 ± 2.2 mg/dL; Mean PTH: 467 ± 78 pg/mL.
- USG and MIBI combined detected 92% of abnormal parathyroid glands.
- FUNE was performed in 87.8% of patients with a low conversion rate (5.2%) to BNE.
- FUNE significantly reduced operation time and hospital stay.
- Single adenoma was found in 93% of cases.
- Surgical success rate was 99.5%.
Conclusions:
- Advanced imaging techniques improve localization and facilitate FUNE.
- FUNE, when performed by experienced surgeons, offers high success rates for PHPT treatment.
- FUNE leads to improved patient outcomes, including shorter hospital stays and reduced operative times.