[Parathyroidectomy and autotransplantation].

Total parathyroidectomy, immediate heterotopic autotransplantation and cryopreservation of parathyroid tissue was introduced in the surgical treatment of drug-resistant renal hyperparathyroidism (rHPT) in 1980 and was performed in 36 patients. During 34 initial bilateral cervical explorations including transcervical thymectomy 142 glands were removed (orthotopic localization: 84%; heterotopic localization: 16%). Supernumerary glands were found in 6 patients (18%; thymus: 3; cervical fatty tissue: 4). The elevated parathyroid metabolism was successfully corrected, in all, but one patient in whom only three glands were removed. Biochemical and clinical follow-up examinations showed a restitution of the symptoms in 88% 3 to 79 months postoperatively. Graft-dependent recurrence of rHPT was diagnosed in one patient. Normocalcemia was reestablished by partially excising the grafted tissue under local anesthesia. Graft-dependent hypoparathyroidism was suspected in one patient because of low levels of serum calcium and parathyroid hormone. Late graft failure was not observed during the follow-up period. None of the patients required delayed autotransplantation of cryopreserved tissue.