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ABSTRACT: The purposes of this study are to evaluate the merits of surgical treatment, including subtotal parathyroidectomy (SP) and total parathyroidectomy (TP), in patients with tertiary hyperparathyroidism (THPT) and compare the outcome of the two surgical options. Medical records of patients undergoing parathyroidectomy for THPT were retrospectively reviewed and long-term outcomes between the two groups were compared. Fourteen out of 488 renal transplantation recipients required parathyroidectomy for THPT during a 24-year follow-up period with a median follow-up of 35.5 [interquartile range (IQR), 19.3-133.3] months. All patients had hypercalcemia, whereas 13 had varying symptoms and one was asymptomatic. Median serum calcium level decreased from 12.4 (IQR, 11.9-12.6) mg/dL preoperatively to 8.9 (IQR, 8.1-9.4) mg/dL postoperatively (P = 0.001), whereas median intact parathyroid hormone (iPTH) dropped from a preoperative level of 340.5 (IQR, 247-540) pg/mL to 55.1 (IQR, 24.4-66.4) pg/mL after surgery (P = 0.018). Comparison between patients receiving TP and SP revealed no difference in incidence of recurrence or permanent complications, whereas the former had significantly lower calcium levels (P = 0.048) and higher phosphorus levels (P = 0.017) compared with the latter. Moreover, a significant reduction in calcium level was noted in TP group on long-term follow-up compared with their immediately postoperative level (8.1 vs 9.0 mg/dL, respectively, P < 0.05), whereas there was no significant decrease in SP group. We concluded that parathyroidectomy is efficient and safe in treating THPT. Because TP would increase the risk of hypocalcemia, a less radical procedure (SP) is preferred.
The American surgeon 05/2012; 78(5):600-6. · 1.28 Impact Factor
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ABSTRACT: Intussusception is familiar to pediatric surgeons but is rarely encountered by general surgeons. Adult intussusception is uncommon, accounting for less than 5% of intestinal obstructions, half of which are associated neoplasms. Intestinal malrotation is usually an incidental finding with unrelated disease on image studies, laparotomy or even autopsy. The major complications of intestinal malrotation are intestinal obstruction secondary to midgut volvulus, internal hernia, or adhesion band. The association of the two entities, which is named Waugh's syndrome in infants, has rarely been reported in the literature. The association in adults is even rarer. We report an adult case with an unusual combination of malrotation and intussusception at exploration.
Digestive Diseases and Sciences 10/2008; 53(11):3037-9. · 2.12 Impact Factor
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ABSTRACT: Total parathyroidectomy with forearm autograft (TP) and subtotal parathyroidectomy (SP) are the two widely-accepted surgical procedures for treating primary parathyroid hyperplasia. Although TP carries an increased risk of permanent hypoparathyroidism and implantation site recurrence, it is still the preferred option of some surgeons. This retrospective study's aim is to confirm the superiority of initial TP when treating primary multiple gland hyperplasia.
All patients who had received parathyroidectomy for primary multiple gland hyperplasia from 1987 to 2007 were reviewed. Two modalities of parathyroidectomy were used; these were subtotal parathyroidectomy (3 (1/2), SP) as the standard initial treatment strategy and TP for disease recurrence or synchronous thyroid abnormality.
A total of 14 patients were treated and these had a median follow-up period of 98 months (range, 51~216). Among these patients, 11 received SP and 3 underwent TP. Seven out of the 11 SP patients (63%) developed postoperative disease recurrence. Of the seven patients who received neck re-exploration, six (85%) demonstrated temporary postoperative hypocalcemia compared with the first operation (14%) (p = 0.003). Four of these patients (57%) experienced recurrent laryngeal nerve palsy, which was significantly higher than the rate after the first operation (0%) (p = 0.006). Therefore, cervical reexploration carried a significantly elevated overall complication rate compared to initial neck exploration (p = 0.002). Of the three initial TP patients, one showed recurrence at the implantation site. All eight recurrence cases underwent re-operations that significantly reduced their serum calcium concentrations (12.55 to 8.7 mg/dL, p = 0.008) and parathyroid hormone levels (135 to 70 pg/mL, p = 0.008) compared with their respective levels just before re-exploration; this group had a 10-year recurrence-free rate of 45%.
Re-operations for recurrent disease are common regardless of the type of primary surgery. Compared with initial TP, re-operation for post-SP disease recurrence was associated with a significantly higher complication rate. TP would seem to be recommended as the choice of initial surgical procedure.
Chang Gung medical journal 33(4):397-406.
