Remedial surgery for primary hyperparathyroidism.

Remedial parathyroid surgery is a complex undertaking for even the most experienced parathyroid surgeon. It involves a careful preoperative evaluation, including the confirmation of the initial diagnosis of primary HPTH, use of the appropriate localization studies, knowledge of the details of the previous exploration, and surgical re-exploration, including the use of intraoperative localization adjuncts, such as the rapid intraoperative PTH assay (Fig. 6). Althoughthe success rate of remedial explorations can be as high as 98%, complication rates are higher than in initial cervical explorations for parathyroid disease.