Results of 150 Subtotal Parathyroidectomies for Secondary Hyperparathyroidism
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ORIGINAL ARTICLE
Results of 150 Subtotal Parathyroidectomies for Secondary Hyperparathyroidism Erhan Aysan 1,2 & Elnur Piraliyev 2 & Samet Yigman 2 Received: 12 June 2019 / Accepted: 6 March 2020 # Association of Surgeons of India 2020
Abstract We evaluated our experience of subtotal parathyroidectomy (SP) for secondary hyperparathyroidism (SHP) cases. We evaluated retrospectively our 150 SP operations due to SHP. Serious hypocalcemia (< 6.5 mg/dL) developed in 23 (15.3%) patients, and we performed cryopreserved parathyroid cell autotransplantation in four cases with successful results. Recurrent hyperparathyroidism developed in 3 (2%) cases, and persistent hyperparathyroidism was observed in 22 (14.6%) cases. Upon reoperation in nine persistent hyperparathyroidism cases, we found supernumerary parathyroid glands in three cases, remnant tissue hyperplasia in four cases, and ectopic parathyroid glands in two cases. Among cases in which four glands cannot be found during surgery, the permanent HP rate is high. Serious hypocalcemia may develop postoperatively, and cryopreserved parathyroid autotransplantation may be inevitable in some of these cases. Keywords Hyperparathyroidism . Secondary . Parathyroidectomy . Subtotal . Parathormone . Calcium . Phosphorus
Introduction The most common cause of secondary hyperparathyroidism (SHP) is chronic renal failure. The mechanism of SHP in chronic renal failure is not clear, but imbalance among serum levels of calcium, phosphate, and vitamin D is an important part of the physiopathological process. Regardless of the mechanism, serum levels of parathormone (PTH) are markedly high and all parathyroid glands exhibit nodular or diffuse hyperplasia [1]. Although the first step in the treatment of SHP is the administration of vitamin D preparations, phosphate-binding pharmaceuticals, and calcimimetic agents, 15–40% of patients do not respond to this treatment and their serum levels of calcium, phosphate, and PTH continue to increase [2]. Subtotal parathyroidectomy (SP) may be necessary in such cases. Successful parathyroid surgery increases patients’ quality of life and contributes to the success of renal * Erhan Aysan [email protected] 1
Faculty of Medicine, Department of General Surgery, Yeditepe University, Istanbul, Turkey
2
Faculty of Medicine, Department of General Surgery Resident, Bezmialem Vakif University, ATA-2 Sitesi, Akasya Cad. No: 25 Cengelkoy, Uskudar, 34900 Istanbul, Turkey
transplantation [3, 4]. In this study, we evaluated the results of SPs that we performed in 150 patients with SHP.
Methods The protocol for this retrospective clinical study was approved by the human ethics committee of Bezmialem Vakif University. All patients were informed about the study, and written informed consent was obtained. Of the 178 patients diagnosed with SHP in the Bezmialem Vakif University Endocrine Surgery outpatient clinic between June 2013 and December 2017, 150 patients (82 men, 68 women; sex ratio, 1.2; age range, 26–69 years; mean age, 39.5 years) were randomized
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