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INITIAL PARATHYROID EXPLORATION: CURRENT TRENDS IN AUSTRALIA
Author(s) -
Sinha Sankar N.,
Subramaniam Peter
Publication year - 1996
Publication title -
australian and new zealand journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.111
H-Index - 51
eISSN - 1445-2197
pISSN - 0004-8682
DOI - 10.1111/j.1445-2197.1996.tb01185.x
Subject(s) - medicine , hypercalcaemia , parathyroid adenoma , audit , hyperparathyroidism , primary hyperparathyroidism , surgery , adenoma , parathyroid neoplasm , general surgery , prospective cohort study , calcium , management , economics
Background: An Australia‐wide multicentre prospective study was undertaken to audit cases of initial parathyroid exploration between 1 January and 31 December 1992. One hundred and sixty‐two cases were audited. The audit was designed to study pre‐operative biochemical assessment, localization techniques and the technique of exploration. Method: A pro forma audit form was circulated to all Australian surgeons known to perform parathyroid surgery. Eleven responded. Results: Free serum ionized calcium (iCa) was measured in 30% of cases, with the majority of pre‐operative calcium assays being performed using total serum calcium (tCa). In 40 cases (29%) pre‐operative localization techniques were used. These proved inaccurate in 10 cases. The intra‐operative technique of localization with methylene blue infusion was used in 11% of cases. All four glands were biopsied in 11 % of cases. No deaths were reported and a postoperative morbidity rate of 3.1 % was noted. Eighty‐eight per cent of patients were discharged within 5 days of surgery with a third going home within 48 h of neck exploration surgery. Only one patient (0.6%) required re‐exploration for persistent hypercalcaemia due to a second adenoma. Conclusions: The surgical treatment of hyperparathyroidism can be regarded as safe, with minimum morbidity in experienced hands. Pre‐operative localization studies in initial parathyroid exploration are not indicated.