Abstract Background Routine open bilateral neck exploration without preoperative localization or intraoperative parathyroid hormone assay has been repeatedly challenged over recent years as the optimal surgical strategy for the treatment of idiopathic primary hyperparathyroidism (HPT). This has prompted a review of the Oxford experience with adherence to traditional practice, questioning whether results could have been improved upon or cost justified by targeting unilateral exploration and immediate hormonal assay. Methods The records of all patients undergoing first-time surgery for idiopathic primary HPT over a 32-year period have been reviewed. In every patient bilateral neck exploration was performed and an attempt made to identify all four parathyroid glands. All macroscopically enlarged glands were removed and the operating time recorded. A successful outcome was defined as normocalcaemia without any therapy at 3-month review after surgery, with good cosmesis. Results Between 1968 and 2000,
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