Due to the complex nature of parathyroid anatomy, embryology and pathology, there will always be some patients that require reoperation for persistent or recurrent hyperparathyroidism. Reoperation is a challenge for even experienced endocrine surgeons and is associated with a higher risk of complications. A retrospective review of patients who underwent reoperative parathyroid surgery over a 17-year period was performed. There were 99 reoperations in 93 patients with persistent or recurrent hyperparathyroidism – 75 persistent cases and 24 recurrent cases. The initial surgery had been performed at other centres in 51 cases. A variety of preoperative localising investigations were utilised in all cases, with Choline PET showing promising results for use in reoperative cases with a detection rate of 95.2%. 88% of patients were successfully cured at their first reoperation. Preoperative localisation is vital for surgical planning and to maximise the chance of successful cure.