Introduction: Surgical management takes place, after a certain period of evolution, on particularly severe forms of secondary hyperparathyroidism, resistant to medical treatment. Subtotal parathyroidectomy is an effective technique in the treatment of these disorders. Method: Our study is retrospective of 33 cases of hyperparathyroidism secondary to chronic renal failure in dialysis patients operated by the 7/8 technique. Identified over a period of 10 years (January 2010 to December 2019), in the ENT department of the Fann University Hospital. Results: Out of 33 cases of secondary hyperparathyroidism, the average age of our patients was 51.24 years with a sex ratio of 0.43. Causal nephropathy was dominated by nephro-angiosclerosis, which was found in 27.27% of cases. Bone pain found in 23 patients or 69.69% was the predominant clinical sign. The average calcemia was 92.7 mg/l. Parathormone was dosed in all our patients and the average was 1611.05 ng/l. The consequences were clinically marked by recurrent paresis in one patient. No case of hematoma or postoperative infection was found. On the biological level 10 patients or 30.30% had a transient hypocalcaemia. The results were marked by a drop in PTH in 23 patients or 78.78% of cases. Conclusion: Subtotal parathyroidectomy remains an effective and beneficial therapeutic method for kidney failure patients with secondary hyperparathyroidism.
References
[1]
Moe, S.M. and Drüeke, T.B. (2003) Management of Secondary Hyperparathyroidism: The Importance and the Challenge of Controlling Parathyroid Hormone Levels without Elevating Calcium, Phosphorus, and Calcium-Phosphorus Product. American Journal of Nephrology, 23, 369-379. https://doi.org/10.1159/000073945
[2]
Block, G.A., Klassen, P.S., Lazarus, J.M., et al. (2004) Mineral Metabolism, Mortality, and Morbidity in Maintenance Hemodialysis. Journal of the American Society of Nephrology, 15, 2208-2218. https://doi.org/10.1097/01.ASN.0000133041.27682.A2
[3]
Hamouda, M., Ben Dhia, N., Aloui, S., et al. (2011) Traitement chirurgical de l’hyperparathyroïdie secondaire chez l’insuffisant rénal chronique. Néphrologie & Thérapeutique, 7, 105-110. https://doi.org/10.1016/j.nephro.2010.10.003
[4]
Fukagawa, M. and Nakanishi, S. (2003) Role of Parathyroid Intervention in the Management of Secondary Hyperparathyroidism. Nephrology Dialysis Transplantation, 18, 23-26. https://doi.org/10.1093/ndt/gfg1006
[5]
De Francisco, A.L.M., Fernandez-Fresnedo, G., Rodrigo, E., et al. (2002) Parathyroidectomy in Dialysis Patients. Kidney International, 63, 161-166. https://doi.org/10.1046/j.1523-1755.61.s80.27.x
[6]
Triponez, F., Kebebew, E., Dosseh, D., et al. (2006) Less-than-Subtotal Parathyroidectomy Increases the Risk of Persistent/Recurrent Hyperparathyroidism after Parathyroidectomy in Tertiary Hyperparathyroidism after Renal Transplantation. Surgery, 140, 990-999. https://doi.org/10.1016/j.surg.2006.06.039
[7]
Veyrat, M., Fessi, H., Haymann, J.P., et al. (2019) Parathyroïdectomie conservatrice des trois quarts, versus parathyroïdectomie subtotale des 7/8e, dans l’hyperparathyroïdie secondaire. Annales françaises d’oto-rhino-laryngologie et de pathologie cer-vico-faciale, 136, 63-69. https://doi.org/10.1016/j.aforl.2018.01.009
[8]
Kim, M.S., Kim, G.H., Lee, C.H., et al. (2020) Résultats chirurgicaux de parathyroïdectomie subtotale pour hyperparathyroïdie rénale. Clinical and Experimental Otorhinolaryngology, 13, 173-178.
[9]
Périé, S., Veyrat, M., Haymann, J.P., et al. (2014) Intérêt des parathyroïdectomies des 3/4, sélectives, versus parathyroïdectomies subtotales des 7/8e dans l’hyperparathyroïdie secondaire. Néphrologie & Thérapeutique, 10, 291-330. https://doi.org/10.1016/j.nephro.2014.07.058
[10]
Bratucu, M.N., Garofil, N.D., Radu, P.A., et al. (2015) Surgical Attitude in Patients with Secondary Hyperparathyroidism Undergoing Dialysis. Chirurgia (Bucur), 110, 418-424.
[11]
Udelsman, R. (2002) Six Hundred and Fifty Six Consecutive Explorations for Primary Hyperparathyroidism. Annals of Surgery, 235, 665-672. https://doi.org/10.1097/00000658-200205000-00008
[12]
Arciero, C.A., Poeples, G.E., Stojadinovic, A., et al. (2004) The Utility of a Rapid Parathyroid Assay for Uniglandular, Multiglandular, and Recurrent Parathyroid Disease. The American Surgeon, 70, 588-592.
[13]
Lorenz, K., Bartsch, D.K., Sancho, J.J., et al. (2015) Surgical Management of Secondary Hyperparathyroidism in Chronic Kidney Disease—A Consensus Report of the European Society of Endocrine Surgeons. Langenbeck’s Archives of Surgery, 400, 907-927. https://doi.org/10.1007/s00423-015-1344-5
[14]
Schneider, R., Slater, E.P., Karakas, E., et al. (2012) Initial Parathyroid Surgery in 606 Patients with Renal Hyperparathyroidism. World Journal of Surgery, 36, 318-326. https://doi.org/10.1007/s00268-011-1392-0
[15]
Tominaga, Y., Uchida, K., Haba, T., et al. (2001) More than 1,000 Cases of Total Parathyroidectomy with Forearm Autograft for Renal Hyperparathyroidism. American Journal of Kidney Diseases, 38, S168-S171. https://doi.org/10.1053/ajkd.2001.27432