Case series of targeted parathyroidectomy with surgeon-performed ultrasonography as the only preoperative imaging study.

BACKGROUND: Targeted parathyroidectomy for treatment of sporadic primary hyperparathyroidism (SPHPT) has become the preferred approach in many centers. Therefore, preoperative localization studies are increasingly important. Although surgeon-performed ultrasonography (SUS) is equivalent to sestamibi scanning (MIBI), many surgeons still obtain either a MIBI or both studies before cervical exploration. The goal of this study was to demonstrate the feasibility of targeted parathyroidectomy guided by intraoperative PTH monitoring (IPM) based on SUS localization alone. METHODS: We studied 136 consecutive patients with SPHPT undergoing parathyroidectomy guided by IPM. Ninety-six (71%) patients had only SUS, whereas 40 (29%) also had a negative MIBI (total n = 136). Pre-, intra- and postoperative data were analyzed to evaluate SUS accuracy in localizing abnormal glands. RESULTS: SUS correctly identified ≥ 1 abnormal gland in 90% (123/136) of the patients. Sensitivity and overall accuracy of SUS was 87% and 88%, respectively. Operative success was 99% with multiglandular disease incidence of 10%. Unilateral neck exploration was possible in the majority of patients. CONCLUSION: Preoperative SUS is accurate in localizing hypersecreting glands; however, IPM remains paramount in determining the extent of neck dissection. The use of SUS as a single imaging method obviates the need for MIBI in most patients and decreases costs of parathyroidectomy guided by IPM.

Volvular small bowel obstruction secondary to adherence of a Meckel's diverticulum at a previous umbilical laparoscopic port site.

This is a case of an otherwise asymptomatic Meckel's diverticulum, which became fibrously adherent to a previous umbilical laparoscopic port site, causing volvulus and small bowel obstruction in a pediatric patient. The diverticulum was diagnosed and resected laparoscopically, remaining bowel viability was maintained, and the child recovered without further sequelae. This complication, though rare, should be considered in the differential diagnosis when a child presents with abdominal pain after undergoing previous laparoscopic surgery. More important, this supports the consideration for the resection of asymptomatic Meckel's diverticulm when discovered incidentally, which is currently a controversial topic.