A second parathyroid operation is necessary in cases of a failed, first parathyroid Operation.

Although, successful parathyroid surgery for is almost guaranteed by expert parathyroid surgeons, many patients have an attempt at parathyroid removal by the occasional parathyroid surgeon. Surgeons who perform occasional parathyroid surgery for hypercalcemia treatment will often be able to remove a single adenoma; however, there are situations where the parathyroid adenoma may be misplaced and may be found anywhere in the neck between the hyoid and mediastinum. Once the gland is not its own location, it can often be missed on routine exploration by a non-parathyroid expert. Patients with hyperplasia are more difficult and often if occasion parathyroid surgeons operate, only one gland may be removed and remaining abnormal glands may have been left behind. It becomes quite common therefore that patients who have had previous surgery and may have persistent primary hyperparathyroidism and persistent calcium level. After parathyroid surgery, calcium levels should be monitored and parathyroid hormone levels should be monitored. Elevated parathyroid hormone levels and elevated calcium levels after parathyroid surgery will result in the same consequences as before surgery. Reoperation is therefore is important. Reoperation is common in the parathyroid centers and can be safe and successful as well. The principles of reoperation are similar to the principles of primary parathyroid surgery in many ways. The localization of the remaining abnormal parathyroid tissue is crucial. In these situations, if the nuclear scan is not diagnostic and the patient has a negative scan, additional testing is essential. For patients undergoing reoperation, MRI scans will add significant additional information. Also, in some cases, ultrasound may add additional information. If the use of ultrasound, MRI scanning, and the nuclear scan does not identify the abnormal remaining tissue, a search of the mediastinum is also essential prior to the definitive secondary exploration. The key to a successful secondary operation is also similar to primary in that they require expertise and an approach to provide safety first and then successful removal of abnormal tissue. The safety features that are used for prime exploration are essential for a reoperation. These include the use of nerve integrity monitoring systems to protect both the superior and recurrent laryngeal nerves. Often, only the recurrent laryngeal nerve is protected. The recurrent laryngeal nerve is the main major nerve that controls our voice. Injury to that nerve could cause significant weakness of the voice with an extremely breathy voice. The superior laryngeal nerve is often overlooked but still is an important nerve to help us with out voice. Injuries to the superior nerve are quite common and cause some mild weakness of the voice. This becomes very significant for professional voice users. Patients who use their voice on a regular basis such as teachers, salesmen, or many other professions where continued voice is essential would suffer significantly with injury to the superior laryngeal nerve. In particular, if the superior laryngeal nerve is not protected, they find that their voice is weaker and tires easily. Of course, if the superior laryngeal nerve is injured, a professional singer would have significant problems. Use of the nerve integrity monitoring system allows both protection of the superior laryngeal nerve and the recurrent laryngeal nerve.

Secondary exploration of the parathyroid should always be multi-gland exploration. Once a single operation has failed to control the disease, it is crucial that the second procedure involves a thorough exploration of all remaining glands and assessment of all the glands. It is also essential that the secondary procedure includes intraoperative assays for parathyroid hormone levels to assure that they return to normal.

With the combination of experience and techniques for safe secondary exploration, the success rate is extremely high, approaching the success rate for primary operations.