Surgical treatment of secondary hyperparathyroidism.

Secondary hyperparathyroidism is a recognized complication which develops in patients on hemodialysis for chronic renal failure. Parathyroidectomy may be required in patients with severe renal osteodystrophy, intractable pruritus, soft tissue and vascular calcifications or neuromuscular abnormalities. Three different operations have been employed in the treatment of patients with secondary hyperparathyroidism: total parathyroidectomy, radical subtotal (3 1/2 gland) parathyroidectomy and total parathyroidectomy with heterotopic autotransplantation. The last technique has been the procedure of choice in our group because the parathyroid mass is effectively reduced, and the results are comparable to those obtained with other techniques. Furthermore, the complication of graft dependent hyperparathyroidism, should it develop, can be managed by excising a portion of the transplanted tissue under local anesthesia.