Results of bilateral neck exploration for primary hyperparathyroidism

Aim of the study: The surgical success rate and clinical outcome after surgery for primary hyperparathyroidism were evaluated in a prospective long-term follow-up study. Patients and methods: 407 patients, 396 with the first manifestation, 6 with recurrent and 5 with persistent disease underwent operation from August 1, 1987 to August 15, 1999. All patients were prospectively investigated in a long-term follow-up study and underwent reexaminations at regular surveillance intervals. The postoperative course is known in 93.9 % of all patients. Results: The prevalence of asymptomatic primary hyperparathyroidism was 5.6 % in our patients. Surgical cure was obtained in 97.7 % of patients after initial neck exploration. In 58 % of the patients with hypercalcaemic syndrome recovery occurred within the first month after surgery. Skeletal symptoms persisted in 24 % of patients two years after the operation. Conclusions: In primary hyperparathyroidism bilateral neck exploration yielded a high surgical success rate and provided long-term relief of symptoms. The morbidity of parathyroid surgery was influenced by a concomitant thyroid resection and a relationship was established between the number of intraoperatively identified parathyroid glands and the morbidity of the operation.