Abstract Aim Revision parathyroidectomy is made necessary by recurrent and persistent parathyroid disease. The aim of this study was to identify specific challenges in revision surgery compared to primary parathyroid surgery. Methods All revision parathyroidectomies performed by a single surgeon in a tertiary referral centre over a 17- year period were identified. Cases were assessed for: demographics; imaging; histology; biochemistry; gland weight, location, and ectopia; and cure rate. Results were compared to a consecutive series of 100 primary parathyroidectomies. Statistical analysis was performed using SPSS software. Results 28 revision surgeries were identified (18 persistent, 7 recurrent, 3 insufficient data). Demographics were well matched. Ultrasound correctly localised the pathological gland in 18% of revision cases, compared to 37% of primary cases. Technetium-sestamibi scanning correctly localised the pathological gland in 71% of revision cases, compared to 69% of primary cases. Preope
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