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[Parathyroidectomy and autotransplantation].

R Roka, B Niederle

    Wiener Klinische Wochenschrift
    |December 19, 1986
    PubMed
    Summary

    Total parathyroidectomy with autotransplantation successfully treated drug-resistant renal hyperparathyroidism (rHPT) in most patients. Symptoms resolved in 88%, with manageable graft-related issues and no need for cryopreserved tissue.

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    Area of Science:

    • Surgery
    • Endocrinology
    • Nephrology

    Context:

    • Drug-resistant renal hyperparathyroidism (rHPT) poses significant challenges.
    • Surgical intervention, including total parathyroidectomy and autotransplantation, has been explored.
    • Cryopreservation of parathyroid tissue offers a potential backup strategy.

    Purpose:

    • To evaluate the long-term efficacy and outcomes of total parathyroidectomy with immediate heterotopic autotransplantation and cryopreservation for rHPT.
    • To assess the rates of symptom correction, recurrence, and complications associated with this surgical approach.

    Summary:

    • A study involving 36 patients with rHPT undergoing total parathyroidectomy, autotransplantation, and cryopreservation was conducted.
    • 142 parathyroid glands were removed, with 16% found in heterotopic locations; supernumerary glands were noted in 18% of patients.
    • Successful correction of hyperparathyroidism was achieved in 35 out of 36 patients, with 88% experiencing symptom resolution during follow-up (3-79 months).
    • One patient had a graft-dependent recurrence, managed by partial graft excision. Graft-dependent hypoparathyroidism was suspected in another. No late graft failures or need for cryopreserved tissue were observed.

    Impact:

    • This surgical strategy effectively manages drug-resistant renal hyperparathyroidism, leading to significant symptom improvement.
    • The technique demonstrates a low rate of serious complications and recurrence, with manageable graft-related issues.
    • Autotransplantation provides a reliable method for preserving parathyroid function, minimizing the need for cryopreserved tissue.

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