{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:18:54Z","timestamp":1761823134585},"reference-count":72,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2009,2,21]],"date-time":"2009-02-21T00:00:00Z","timestamp":1235174400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2009,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Although most patients with primary hyperparathyroidism (PHPT) are ideal candidates for minimally invasive parathyroidectomy, some will have more than one enlarged gland and require bilateral neck exploration to achieve biochemical cure. We evaluated the clinical evidence for when to choose bilateral neck exploration for patients with PHPT.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We searched PubMed for English\u2010language studies published from 1996 to 2008. The level of clinical evidence was determined according to the criteria proposed by Sackett (Chest 95[2 Suppl]:2S, 1989), and the grade of recommendation was established according to the criteria proposed by Heinrich et al. (Ann Surg 243:154, 2006).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Level III\u2013IV evidence shows that patients with multiple endocrine neoplasia (MEN) 1 and PHPT should have a bilateral neck exploration (grade C recommendation). Only level IV evidence indicates that patients with familial PHPT should do so (no recommendation). Although most patients with MEN 2A have single\u2010gland disease, bilateral neck exploration is still indicated, because they will have either a therapeutic or prophylactic total thyroidectomy for medullary thyroid cancer. A history of head and neck irradiation is associated with PHPT, but the risk of multi\u2010gland parathyroid disease is apparently no higher than in sporadic cases (<jats:italic>level IV evidence, no recommendation<\/jats:italic>). Previous or current lithium therapy confers a higher risk of multi\u2010gland disease (25%\u201345%; level IV\u2013V evidence), which may require bilateral neck exploration. Preoperative localizing studies reliably identify most patients with single\u2010gland but not multi\u2010gland disease (level II\u2013IV evidence). Negative localizing studies confer an approximately 50% risk of multi\u2010gland disease and indicate that bilateral neck exploration is necessary. If two localizing studies are concordant, few patients will require bilateral neck exploration (<jats:italic>level IV, no recommendation<\/jats:italic>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>No level I or II evidence reliably identifies preoperative clinical risk factors for determining which patients should have routine bilateral neck exploration for multi\u2010gland disease or for intraoperative decision making to convert to bilateral neck exploration. Imaging studies are positive in most patients (level II). No randomized studies exist to determine when a bilateral neck exploration is indicated based on clinical risk factors or imaging studies that may suggest multi\u2010gland disease.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-009-9941-5","type":"journal-article","created":{"date-parts":[[2009,2,20]],"date-time":"2009-02-20T19:39:00Z","timestamp":1235158740000},"page":"2282-2291","source":"Crossref","is-referenced-by-count":19,"title":["Bilateral Neck Exploration in Primary Hyperparathyroidism\u2014When Is It Selected and How Is It Performed?"],"prefix":"10.1002","volume":"33","author":[{"given":"Jacob","family":"Moalem","sequence":"first","affiliation":[{"name":"Department of Surgery University of California, San Francisco Box 1674 94143 San Francisco CA USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marlon","family":"Guerrero","sequence":"additional","affiliation":[{"name":"Department of Surgery University of California, San Francisco Box 1674 94143 San 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