Background: During the last decade, the surgical management of primary hyperparathyroidism has been limited to those patients with symptoms or complications of the disease and most surgeons have advocated routine bilateral neck exploration. Several recent articles, however, have supported the role of early surgical intervention and minimally invasive surgery for these patients. The aim of this study was to define the current surgical management of primary hyperparathyroidism in the UK and Ireland.
Methods: A postal questionnaire was sent to all consultant members of the British Association of Endocrine Surgeons in November 2000. The surgeons were asked about their current criteria for patient selection, methods of pre-operative localisation, imaging technique before re-exploration, operative technique and follow-up.
Results: Questionnaires were returned from 66 of 92 surgeons (response rate 71.7%) currently performing parathyroid surgery in the UK and Ireland, at an average of 23.1 parathyroidectomies performed per annum (range, 5-120). The majority of patients referred for surgery were either asymptomatic (12.1%) or minimally symptomatic (53%). There was marked variability among surgeons in the use of pre-operative imaging techniques before the initial operation (sestamibi used by 39.4% [26/66] and ultrasound by 39.4% [26/66] also, alone or in combination with other imaging techniques, while 39.4% (26/66) of surgeons used no imaging) and re-exploration.
Conclusions: This survey demonstrates marked variation in pre-operative localisation and surgical management of patients with primary hyperparathyroidism. The majority of surgeons in the UK and Ireland currently perform bilateral neck exploration with or without pre-operative localisation.