| [ Summary ] |
Secondary hyperparathyroidism (2°HPT), induced by chronic renal failure is one of the most serious problems for uremic patients. It is clear that 2°HPT induces not only osteitis fibrosa but is also associated with high mortality rates, due to cardiovascular complications. Patients with advanced 2°HPT, refractory to medical treatment, require parathyroidectomy (PTx). These patients have a high risk of progression of HPT after PTx because they may possibly have some genetic factors which induce progression of HPT, and there is often poor drug compliance. All parathyroid glands in patients with 2°HPT are fundamentally hyperplastic, then even if small glands remain at PTx, the risk of progression of HPT persists. We should recognize that they have a high risk of recurrent HPT and provide adequate medical treatment to avoid recurrence and the necessity for further operations. To prevent persistent/recurrent HPT, all glands, including supernumerary glands, should be removed during the initial operation. Total PTx with forearm autografting is a suitable operative procedure for advanced 2°HPT, because it is an easy and less invasive way to move enlarged autografts into the forearm under local anesthesia when there is recurrent HPT. |