Reoperative parathyroid surgery

Reoperative parathyroid surgery can be technically challenging and exposes the patient to a higher risk of complications than initial parathyroidectomy. Initial surgical failure can be avoided by thorough, bilateral exploration by an experienced parathyroid surgeon or by the use of intraoperative parathyroid hormone (PTH) monitoring if a limited exploration is planned. Before undertaking a reoperation for hyperparathyroidism the patient must be fully reevaluated including a reassessment of the need for surgery, a review of all previous surgical and pathology reports, and the performance of imaging studies to identify the location of the missing gland. An understanding of parathyroid embryology and anatomy helps identify possible locations of missing glands. The specific surgical approach is dictated by the anticipated location of the abnormal gland. Intraoperative PTH monitoring can limit the extent of reoperative surgery. Recurrent laryngeal nerve monitoring can help decrease the risk of complications.