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I reinterventi nell’iperparatiroidismo

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Riassunto: I reinterventi nell’iperparatiroidismo.
M. Camandona, G. Balbo, S. Catalano, I. Lettini, G. Gasparri

I reinterventi in chirurgia paratiroidea rappresentano una sfida impegnativa per il chirurgo che deve valutare attentamente i dati operatori e istologici del primo intervento, usare una diagnostica accurata preoperatoria con ecografia e scintigrafia con sestamibi e avere ben presente l’anatomia e l’embriologia delle ghiandole paratiroidee. Elementi fondamentali per ottenere un successo chirurgico sono l’uso del dosaggio intraoperatorio del paratormone e una grande esperienza del chirurgo. Seguendo tali principi si arriva a ottenere una remissione del quadro iperparatiroideo nell’85-90% per l’HPT I e nel 70% per l’HPT II e III.
Gli Autori presentano la loro casistica di 75 reinterventi dopo HPT I e di 85 reinterventi dopo HPT II e III, su una casistica totale di 2072 interventi di paratiroidectomia eseguiti fra gennaio 1975 e ottobre 2009.

English version
Summary: Reoperations in hyperparathyroidism.
M. Camandona, G. Balbo, S. Catalano, I. Lettini, G. Gasparri

Reoperative parathyroidectomy (PTx) is challenging for the surgeon. Before reintervention it is essential to evaluate the operative notes and pathology reports from the previous operation, the localization exams (sestaMIBI scintigraphy and ultrasound) and IOPTH assay are also essential. The surgeon is supposed to perfectly know the anatomy and embryology of parathyroid glands and experience with parathyroid surgery is still the most important predictor of success in reoperative PTx. Reinterventions in HPT have good results with a resolution of hyperparathyroidism in 85-90% for primary HPT and in 70% for secondary and tertiary HPT.
Authors present their experience of 76 reinterventions after HPT I and 85 reinterventions after HPT II and III over a total of 2072 parathyroidectomies, carried out between January 1975 and October 2009.

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