Results of reoperation for hyperparathyroidism, with evaluation of preoperative localization studies.

During the past 3 years (June, 1974, to July, 1977), 51 patients underwent reoperation for persistent or recurrent hyperparathyroidism at the Mayo Clinica. The overall success rate for cervical reoperation was 72% and for mediastinal reoperation, was 64%. Arteriography alone provided accurate preoperative localization of missing parathyroid tumors in 11 of 17 patients at a cost per patient benefited of approximately $1,700. Selective thyroid venous sampling with parathormone assay alone correctly lateralized hyperfunctioning glands in only four of nine patients at a cost per patient benefited of approximately $1,900. When used in combination, these studies provided correct localization or lateralization of parathyroid tumors in five of seven patients at a cost per patient benefited of approximately $2,000. Three patients experienced significant neurological complications as a result of thyrocervical arteriography. There were no complications due to venous sampling. In patients who has undergone a less than thorough initial explorations due to venous sampling. In patients who had undergone a less than thorough initial exploration of the neck, the success rate for reoperation was not enhanced by obtaining preoperative tumor localization studies. However, in those patients who had had a thorough and systematic exploration of the neck at their first operations, the success rate for reoperation was almost doubled when preoperative arteriography or venous sampling (or both) was employed.