Minimally invasive parathyroid exploration for solitary adenoma. Initial experience with an open, 'short incision' approach.

BACKGROUND: In the vast majority of patients with primary hyperparathyroidism (HPT) the causative pathology is a benign solitary adenoma. The conventional surgical approach for HPT has involved bilateral cervical exploration with attempted identification of all four parathyroids and resection of enlarged glands. However, in recent years new techniques have permitted accurate preoperative localisation of the single parathyroid tumour in many patients. This has facilitated a focused unilateral operation to be performed in patients with a solitary parathyroid adenoma. More recently we have progressed to a minimally invasive surgical approach for such individuals in whom the tumour has been localised preoperatively. PATIENTS & METHODS: Between September 2004 and July 2006, 24 patients with proven HPT, underwent focused, unilateral cervical exploration through a short (2.5-3 cm) incision placed low on the appropriate side of the neck. Preoperatively, each patient had been shown to have a single focus of activity after parathyroid isotope scanning. RESULTS: There were 21 females and 3 males in the study group with a mean age of 61.5 years (range 25 - 84 years) at the time of operation. The approach was successful in 22 patients with a mean operating time of 49 minutes (range 22-85 minutes). Postoperatively, the serum calcium level returned to normal in every patient and has remained so during a mean follow up period of 11.5 months (range 1-22 months). No individual developed postoperative hypocalcaemia although one patient developed a temporary unilateral vocal cord paralysis. CONCLUSION: A short incision cervical approach for HPT due to solitary adenoma is a viable alternative for appropriately selected patients.

Diverticular abscess presenting as a strangulated inguinal hernia: case report and review of the literature.

Potentially life threatening diseases can mimic a groin hernia. We present an unusual case of diverticulitis with perforation and a resulting abscess presenting as a strangulated inguinal hernia. The features demonstrated were not due to strangulation of the contents of the hernia but rather pus tracking into the hernia sac from the peritoneal cavity. The patient underwent sigmoid resection and drainage of retroperitoneal and pericolonic abscesses. Radiological and laboratory studies augment in reaching a diagnosis. The differential diagnosis of inguinal swellings is discussed.