Hyperparathyroidism: problems in surgical management.

A retrospective study of 210 patients who had 225 operations for hyperparathyroidism over a 20 year period has been reported. These patients were operated on by 20 staff surgeons, 12 of whom performed such an operation less than five times for this disease during the study period. There was a significant operative and postoperative morbidity of about 8 percent. There was one postoperative death, and two patients died later of related problems. The recurrence rate was 1 percent. The total rate of untoward results was about 18 percent. The success rate of primary operations was 95 percent (71 percent for reoperations). These findings were similar to those in many published reports, but were less than satisfactory. It is possible that results could be improved by putting such patients in the care of experienced surgeons. Careful identification of all of the parathyroid glands is essential to obtain satisfactory results. There was an unusually large incidence of this disease in patients with thyroid disease, immobilization, and thiazide intake. There was a correlation between the preoperative serum calcium levels and the size of the parathyroid tumors that were removed. An interesting "rebound" postoperative hypercalcemia has been described.