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Surgical management of secondary hyperparathyroidism 

Surgical management of secondary hyperparathyroidism
Chapter:
Surgical management of secondary hyperparathyroidism
Author(s):

Emile Sarfati

and Tilman B Drüeke

DOI:
10.1093/med/9780199559176.003.031
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date: 07 August 2020

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.

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