Surgical treatment of secondary hyperparathyroidism in patients with chronic renal failure by sub-total parathyroidectomy.

The majority of patients with secondary hyperparathyroidism caused by chronic renal insufficiency are successfully managed medically. However, approximately 5-10 per cent develop refractory symptoms such as bone pain and pruritus requiring palliative surgical treatment. We present a series of 16 consecutive patients who were managed with sub-total parathyroidectomy over a 6-year period. With follow-up of 12-60 months, there were no operative mortalities or significant perioperative morbidities. All patients had significant improvement or resolution of their symptoms. All had biochemical improvement with reductions in their serum calcium and parathormone levels. No patients have required re-exploration for persistent or recurrent hyperparathyroidism, and there have been no cases of permanent hypoparathyroidism. We feel that sub-total parathyroidectomy remains the optimal treatment for refractory secondary hyperparathyroidism. It offers several advantages over total parathyroidectomy with autotransplantation.