Chapter

Surgical management of secondary hyperparathyroidism

Emile Sarfati and Tilman B Drüeke

in The Spectrum of Mineral and Bone Disorders in Chronic Kidney Disease

Second edition

Published on behalf of Oxford University Press

Published in print June 2010 | ISBN: 9780199559176
Published online November 2012 | e-ISBN: 9780191753350 | DOI: http://dx.doi.org/10.1093/med/9780199559176.003.031

Series: Oxford Clinical Nephrology Series

Surgical management of secondary hyperparathyroidism

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The surgical management of severe secondary hyperparathyroidism in patients with chronic kidney failure remains the ultimate solution in those who fail to respond to medical treatment or cannot comply with it. Among the various surgical techniques available, the most frequently used are subtotal parathyroidectomy, total parathyroidectomy with immediate autotransplantation of parathyroid tissue, total parathyroidectomy without autotransplantation, and total parathyroidectomy with delayed autotransplantation. At present, we prefer performing subtotal parathyroidectomy. Local and general contraindications to parathyroidectomy include erosive cervical spondylarthropathy and several systemic diseases. The presence of severe cardiac or pulmonary failure may be a contraindication to general anesthesia. In such cases, local anesthesia with two successive lateral cervictomies may be exceptionally used.

Chapter.  6541 words.  Illustrated.

Subjects: Rheumatology ; Nephrology

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