Surgical management of hyperparathyroidism.

Objective: To determine the efficacy of focused parathyroidectomy for adenoma and total parathyroidectomy with forearm autotransplantation for hyperplasia in maintaining serum calcium levels. Study Design: Observational case series. Place and Duration of Study: Department of General Surgery (Ward-2), Jinnah Postgraduate Medical Centre, Karachi, from January, 2002 to December, 2004. Patients and Methods: Sixteen patients were admitted in this time period. Eleven of these patients had primary hyperparathyroidism and 4 had secondary hyperparathyroidism due to chronic renal failure. Pre-operative localization was done with Sestamibi scan and ultrasound of neck while methylene blue was used for intra-operative localization. All patients with primary hyperparathyroidism had single gland disease and were treated with focused parathyroidectomy. In 4 patients with parathyroid hyperplasia, total parathyroidectomy with forearm autotransplantation was done. Results: In the postoperative period, 3 patients developed hypocalcemia but they were managed on oral calcium and vitamin-D supplements. All of the remaining patients became normocalcaemic and there were no major complications. Mean hospital stay was 7-days. Conclusion: Focused parathyroidectomy for single gland disease and total parathyroidectomy with forearm auto-transplantation for hyperplasia was a satisfactory treatment for patients in this series.