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At least 433 records · Page 24Linked to original sources
PubMed2004

Late laparoscopic reoperation of failed antireflux procedures.

Failures of antireflux procedures occur in 5% to 10% of the patients. Our objective is to report our experience with laparoscopic management of failed antireflux operations. Of 1698 patients who underwent laparoscopic treatment of gastroesophageal reflux disease (GERD), 53 were reoperations following either a previous open or laparoscopic antireflux procedure. The indications for surgical reoperation were persistent or recurrent GERD in 35 patients (66%), presence of paraesophageal hiatal hernia in 4 (7.5%), and severe dysphagia in 14 (26.4%). Hospital stay varied from 1 to 8 days, with an average of 1.2 days. Conversion to open laparotomy occurred in 10 patients (18.8%). The main causes for persistent or recurrent GERD were herniation (n=20) and disruption (n=12) of the fundoplication. Two patients had both herniation and disruption of the fundoplication. The main reason for severe dysphagia was tight hiatus. The most common reoperations were hiatal repair for hernia correction (n=26), redo fundoplication (n=16), and widening of the hiatus (n=12). Two patients had both hiatal repair and redo fundoplication. Intra (n=5) and postoperative (n=16) complications were frequent, but they were usually minor. There was no mortality. The present study demonstrated that laparoscopic reoperation for failed antireflux procedures may be performed safely in most patients with excellent result, low severe morbidity, and no mortality.

Adult↗
PubMed2004

Evaluation with alpha-[11C]methyl-L-tryptophan positron emission tomography for reoperation after failed epilepsy surgery.

PURPOSE: Reoperation after failed cortical resection can alleviate seizures in patients with intractable neocortical epilepsy, provided that previously nonresected epileptic regions are accurately defined and removed. Most imaging modalities have limited value in identifying such regions after a previous surgery. Positron emission tomography (PET) using alpha-[11C]methyl-L-tryptophan (AMT) can detect epileptogenic cortical areas as regions with increased tracer uptake. This study analyzed whether increased cortical AMT uptake can detect nonresected epileptic foci in patients with previously failed neocortical resection. METHODS: Thirty-three young patients (age 3-26 years; mean age, 10.8 years) with intractable epilepsy of neocortical origin, and a previously failed cortical resection performed at various epilepsy centers, underwent further presurgical evaluation for reoperation. AMT-PET scans were performed 6 days to 7 years after the first surgery. Focal cortical areas with increased AMT uptake were objectively identified and correlated to ictal EEG data as well as clinical variables (age, postsurgical time, etiology). RESULTS: Cortical increases of AMT uptake were detected on the side of the previous resections in 12 cases. In two patients scanned shortly (within a week) after surgery, diffuse hemispheric increases were observed, without any further localization value. In contrast, in 10 (43%) of 23 patients scanned >2 months but within 2.3 years after surgery, focal cortical increases occurred, concordant with seizure onset on ictal EEG. Age, etiology (lesional vs. cryptogenic), epileptiform EEG activity during PET, or time of the last seizure were not significantly related to the presence of increased AMT uptake. All patients with localizing AMT-PET, who underwent reoperation, became seizure free (n = 5) or showed considerable improvement of seizure frequency (n = 2). CONCLUSIONS: AMT-PET can identify nonresected epileptic cortex in patients with a previously failed neocortical epilepsy surgery and, with proper timing for the scan, can assist in planning reoperation.

Adolescent↗
PubMedDate not supplied

Pathogenesis of postoperative candidosis: no detectable fungemia during reoperations after abdominal surgery.

Pathogenesis of systemic candidosis in surgical patients is unsettled. Results from animal models suggest that invasion from colonized intestine is the major portal of entry into circulation. To study the mechanisms of systemic candidosis in surgical patients after intestinal surgery, multiple blood cultures were taken during reoperations with manipulation of the intestinum to detect possible perioperative fungemia. The lysis centrifugation method (Isolator) was used for blood cultures. Of the 30 subjects in the material, 12 were demonstrated to be colonized with yeast before the reoperation. Three patients had positive blood cultures during reoperation, but no yeasts were found in the 146 perioperative blood cultures. Three patients had severe nonsuperficial yeast infection after reoperation, but none had disseminated candidosis. This finding in high risk patients supports the view that immediate perioperative fungemia and persorption from colonized intestinum is rare. However, persorption may occur later via healing wounds of the colonized intestinum. Both persorption and the exogenous route (e.g. vascular catheters) are possible in the pathogenesis of postoperative candidosis.

Abdomen↗
PubMed1990

An approach to reoperative median sternotomy.

Cardiac reoperations using a previous median sternotomy incision are becoming more common as the population of patients who have had cardiac surgery increases. Repeat median sternotomy can be complicated by major hemorrhage and secondary myocardial ischemia. A standard approach to reoperative median sternotomy has been developed over the past several years at Georgetown University. Details of the method are presented. From January 1, 1980 through April 30, 1988, 179 patients underwent repeat median sternotomy. The technical approach to the operation became standard as of July 1,1983. Two of 66 patients operated before this date sustained major hemorrhage requiring emergent institution of cardiopulmonary bypass. One mortality in the group was directly related to hemorrhage at the sternotomy. No episode of major hemorrhage and no mortality related to the sternotomy occurred in 113 patients who underwent repeat sternotomy after July 1, 1983. Reoperation for bleeding occurred in 8.4% of the patients. We believe the technical considerations presented increase the safety of reoperative cardiac surgery.

Blood Loss, Surgical↗
PubMedDate not supplied

Mini-reoperative mitral valve surgery.

BACKGROUND: Reoperative surgery involving the atrioventricular valves places the patient at risk for cardiac or bypass graft injury upon reoperative sternotomy. Standard right thoracotomy can avoid these problems but is associated with a large incision and possibly more pulmonary complications. METHODS AND RESULTS: An alternative, minimally invasive approach for reoperative atrioventricular valve surgery was studied in 22 patients. Patient age was 66 +/- 10 years. Postoperative mitral regurgitation was 3.4 +/- 0.3 and New York Heart Association (NYHA) Class was III/IV, despite a mean ejection fraction of 44 +/- 14%. These patients had 1-4 prior procedures a mean of 5 years previously. An anterior 5th interspace incision of 5- to 10-cm was performed. A 1-cm segment of 5th rib was removed to facilitate exposure. Cardiopulmonary bypass was performed via ascending aorta or femoral artery cannula and bicaval venous cannulae. Systemic cooling (25 degrees) and fibrillatory arrest was used. Operations performed included mitral valve repair (12), mitral valve replacement (5), prosthetic mitral valve rereplacement (4), repair of perivalvular leak (3), tricuspid valve repair (5), and atrial septal defect closures (7). Mean bypass time was 109 +/- 21 minutes with a mean fibrillatory time of 62 +/- 12 minutes. There was no intraoperative or 30-day mortality. Patients were weaned from ventilation at a mean of 5 hours postoperatively and received 1.3 +/- 1 unit of blood. There were no wound complications or re-explorations for bleeding. At a mean follow-up of 15 +/- 8 months, survivors are NYHA Class I-II. When interviewed, all patients felt their recovery was more rapid and less painful than their original sternotomy. CONCLUSION: This minimally invasive approach to reoperative atrioventricular valve surgery is safe and technically feasible. It has become our preferred approach to the atrioventricular valves in patients with a previous sternotomy.

Aged↗
PubMedDate not supplied

Limited access left thoracotomy for reoperative coronary artery disease: on or off pump.

Between 1971 and 1988 left thoracotomy was performed on pump for selected reoperations. Since 1993, 92 patients were operated on with a limited approach and an increased number of cases were done off pump (70 patients). The purpose of this paper is to describe the transition of our operative techniques from on pump to off pump for reoperative coronary patients. From 1995 to 1999, 22 patients (Group 1) were operated on pump and 70 patients (Group II) off pump; 86 of 92 (93.5%) had reoperations. The demographic data were similar in these two groups regarding age, gender, ejection fraction, and total number of grafts performed. In this study 92 patients had a crude mortality of 4.3%. Limited access thoracotomy provides safer reoperation than previously (1971-1988) with an improved on or off pump (4.5% vs. 4.3%) mortality, compared to the on pump mortality of 10% between 1971-1988. Off-pump operations are performed with increasing frequency and with the same risk and less postoperative complications.

Aged↗
PubMedDate not supplied

A novel synthetic sealant to treat air leaks at cardiac reoperation.

PURPOSE: Pulmonary injury with resultant air leak is common at cardiac reoperation. Sequelae of this complication include prolonged chest tube drainage and time to ambulation, extended hospitalization and increased costs, and mediastinitis. The purpose of this study was to test the efficacy of a new synthetic absorbable sealant at treatment air leaks occurring at cardiac reoperation. PATIENTS AND METHODS: Fifteen patients having cardiac reoperation had lung injuries repaired with FocalSeal-L Sealant (Focal, Inc., Lexington, MA). Mean age was 61+/-15 years, and mean interval from the previous to the current operation was 44+/-38 months. RESULTS: In all patients, FocalSeal-L Sealant was successful at sealing intraoperative air leaks. Postoperatively, 73% of patients had no air leak. Four patients (27%) developed a recurrent air leak, three on postoperative day 1 and one on postoperative day 2. In three of these patients, the air leak sealed within 3 days. In the fourth patient, an immunosuppressed heart transplant recipient with mediastinitis, the air leak never sealed; that patient died of sepsis after an omental flap failed to control the air leak. In patients without air leak, chest tubes were removed on postoperative day 1 (9 patients) or 2 (1 patient). CONCLUSION: This novel synthetic sealant prevents postoperative air leaks in the majority of patients suffering lung injury at cardiac reoperation.

Biocompatible Materials↗
PubMedDate not supplied

A minimally invasive alternative approach for reoperative grafting of the right coronary artery.

BACKGROUND: Target vessel revascularization on a beating heart via a mini subxiphoid incision, not only eliminates the hazards of sternal reentry, but also avoids the detrimental systemic effects of extracorporeal circulation. AIM: The goal of the study was to develop and describe a safe and effective method to revascularize the right coronary artery in reoperative cases, using beating heart and minimally invasive techniques in lieu of the RGEA. METHODS: There were three men and four women with a mean age of 69 years; four were second time reoperations and three third time reoperations. Through a subxiphoid approach, a lower ministernotomy is performed. Once the coronary target is established, a Rultract retractor is used to gently elevate the right half of the sternum to take down the RITA. A mechanical stabilizer was used to provide stabilization for distal anastamoses. Flow was measured in all the grafts with the Medi-Stim before and after protamine administration. RESULTS: [table: see text] CONCLUSION: We believe that this technique provides another effective approach to the patient who requires reoperative coronary revascularization of the RCA.

Aged↗
PubMed2005

Temporal lobe epilepsy: analysis of failures and the role of reoperation.

PURPOSE: To analyze failures and reoperations in temporal lobe epilepsy (TLE), and compare these patients with those seizure-free, and to determine any significant differences between the groups. METHODS: A total of 262 patients with TLE, treated surgically between 1984 and 2002, were followed at 3, 6 and 12 months and yearly thereafter. Sixty-five percent became seizure-free (class I), 19% had rare seizures (class II), and 16% continued to have seizures (classes III and IV). Patients in classes III and IV underwent re-evaluation, and were compared with seizure-free patients. RESULTS: Analysis of failures (n = 41): 12% had febrile seizures (FS), 29% head trauma, 7% encephalitis, 52% abnormal imaging, 34% bitemporal spiking, and 20% posterior temporal localization. Post-surgical MRI (available in 30 of 41 patients) showed residual posterior mesial temporal structures (PMTS) in 86.6%, PMTS and posterior temporal lesions (PTLs) in 6.6%, and PTLs in another 6.6%. Twenty-one had reoperation, 14 had resection of the PMTS, five of the PMTS and basal posterior temporal cortex, and two of the PMTS, and PTLs. There was no surgical mortality or morbidity; 57% became seizure-free and 24% had rare seizures. Seizure-free patients (n = 170): 45% had FS, 12% head trauma and 70% abnormal imaging studies. CONCLUSION: When compared with seizure-free patients, patients who failed TLE surgery were less likely to have a history of FS and abnormal imaging, and more likely to have a history of head trauma, encephalitis and posterior temporal localization, suggesting larger epileptogenic zones. Following reoperation, 57% became seizure-free. Predictors of a good outcome after reoperation were anterior temporal localization and abnormal imaging studies.

Adolescent↗
PubMed1999

Early retreatment of infantile esotropia: comparison of reoperation and botulinum toxin.

AIM: To compare the efficacy of reoperation and botulinum toxin injection in treating infantile esotropes early after unsatisfactory surgical alignment. METHODS: 55 strabismic children who had been unsuccessfully operated for infantile esotropia were randomised to reoperation (28 patients) or botulinum toxin injection (27 patients). The motor outcomes (percentage of successful motor outcome and percentage change in deviation) were compared at 6 months, 1 year, and 3 years after retreatment, and the sensory outcomes (percentage with fusion ability and stereo perception) at the 3 year follow up visit. RESULTS: The motor and sensory outcomes and the stability of motor results were similar in patients reoperated and treated with botulinum injection. At the 3 year visit 67.8% and 59.2% of children were, respectively, within 8 prism dioptres of orthotropia (p=0.72). The frequency of fusion ability was, respectively, 60.7% and 51.8% (p=0.71), and the frequency of stereo perception (</=400 seconds of arc, Randot circles), 57.1% and 48.1% (p=0.70). The botulinum injection was more likely to be effective when carried out in the 6 months following initial surgery. CONCLUSIONS: Botulinum injection is a rapid and less invasive alternative to reoperation in children who have been unsuccessfully treated with surgery to correct infantile esotropia.

Anti-Dyskinesia Agents↗
PubMed1983

Reoperation after aortocoronary bypass procedure. Results in 53 patients in a group of 1041 with consecutive first operations.

Of 1041 patients with consecutive aortocoronary bypass operations, 53 (5.1%) underwent reoperation during a mean follow-up time of three and a half years. The operative mortality of first operations was 1.2%, and of reoperations 3.8%. The anatomical reason for reoperation was failure of the bypass graft in 41 (77%) patients, which in 18 was accompanied by progression of disease. Progression alone was seen in seven (13%). When symptoms occurred within six months after the first operation, failure of the bypass graft(s) was nearly always found--in 32 out of 36 instances. Progression in non-bypassed arteries was seen only when symptoms occurred later. Late results in angina pectoris were less favourable in the group undergoing reoperation: 31 (65%) of the 48 operated on twice and 406 (46%) of the 877 patients operated on once still had angina at late follow-up. The same fraction in both groups was improved by operation: 88% versus 89%.

Adult↗
PubMed1998

Long-term results of reoperations for recurrent angina with internal mammary artery versus saphenous vein grafts.

OBJECTIVE: To evaluate the long term results of coronary reoperations for recurrent angina with internal mammary (thoracic) arteries versus vein grafts. DESIGN: Inception cohort of 103 patients with a mean follow up of 7.1 years (range 1.0-11.6). SETTING: Regional cardiothoracic centre. PATIENTS: Among 103 consecutive patients, mean (SD) age 61.8 (9.7) years, who were reoperated for recurrent angina between January 1982 and December 1991, 53 patients had unilateral or bilateral internal mammary artery (IMA) grafting supplemented or not with saphenous vein (SV) grafts (group A), and 50 patients underwent reoperative coronary surgery using SV grafts only (group B). The two groups were comparable in terms of demographic and clinicopathological data. MEASUREMENTS AND RESULTS: Operative mortality was 5.6% (95% confidence interval 4.6 to 6.6) for group A, and 10% (8.2 to 11.8) for group B (p > 0.05). Probability of freedom from new recurrence of angina was 86% at 5 and 10 years in group A, compared with 56% and 25% respectively in group B (p = 0.005). Freedom from cardiac events was estimated to be 81% at 5 and 10 years in group A, v 52% and 20% for group B, respectively. Actuarial survival was 95% v 93% at 3 years, 95% v 85% at 5 years, and 88% v 71% at 10 years after reoperation (p > 0.05). CONCLUSIONS: The long term results of IMA are superior to SV grafts in terms of freedom from new recurrence of angina and other cardiac events. The IMA is thus the conduit of choice in coronary revascularisation.

Adult↗
PubMed1994

A prospective, randomized study of spinal cord stimulation versus reoperation for failed back surgery syndrome: initial results.

Spinal cord stimulation (SCS) has been reported to be effective treatment for the failed back surgery syndrome in a number of retrospective case series. Its retrospectively reported results compare favorably with those of neurosurgical treatment alternatives, such as reoperation and ablative procedures. There has been no direct prospective comparison, however, between SCS and other techniques for pain management. We have undertaken a prospective, randomized comparison of SCS and reoperation in patients with persistent radicular pain, with and without low back pain, following lumboscral spine surgery. Patients selected for reoperation by standard criteria have been randomly assigned to initial treatment by one or the other technique. The primary outcome measure is the frequency of crossover to the alternative procedure, if the results of the first have been unsatisfactory after 6 months. Results for the first 27 patients reaching the 6-month crossover point show a statistically significant (p = 0.018) advantage for SCS over reoperation. This is one of many potentially important outcome measures, which are to be followed long-term as a larger overall study population accrues.

Back Pain↗
PubMed1995

In-hospital and long-term outcome after reoperative coronary artery bypass graft surgery.

BACKGROUND: Increasingly over the past several years, patients have returned after coronary surgery for reoperative procedures, and the experience has become substantial. In this report, we describe immediate- and long-term outcomes after reoperative coronary artery bypass graft surgery. METHODS AND RESULTS: The source of data was the clinical database at Emory University. The surgical procedure and statistical methods were standard. Data were collected prospectively and entered into a computerized database. Follow-up was by letter, telephone, or hospital records documenting additional events resulting in readmission. In-hospital correlates of survival were determined by logistic regression, and long-term correlates were determined by Cox model analysis. There were 2030 patients with a mean age of 61 and a mean of 7.8 +/- 4.1 years since the first surgery. The mean ejection fraction was close to 50%, and the majority had three-vessel or left main disease. Urgent or emergency surgery was required in 16.6%. The internal mammary was used in 60.1%. Q-wave myocardial infarctions occurred in just over 5%. Neurological events increased from 1.2% at less than age 50 to 4.1% at more than age 70. The hospital mortality increased from 5.7% at less than age 50 to 10% at more than age 70, with an overall rate of 7.0%. Mortality was 5.7% for elective, 10.9% for urgent, and 16.4% for emergency cases. Angina was noted at follow-up in 41.3%. Urgent or emergency surgery, reduced ejection fraction, hypertension, older age, and female sex were univariate and multivariate correlates of in-hospital death. Diabetes was a univariate correlate only. Five- and 10-year survival rates were 76% and 55%, respectively. Five- and 10-year myocardial infarction-free survival rates were 63% and 40%, respectively. By 12 years, few patients were free of cardiac events. The univariate and multivariate correlates of long-term mortality were older age, reduced ejection fraction, hypertension, diseased vessels, presence of diabetes, congestive failure, and emergency surgery, with a strong trend for female sex. The use of the internal mammary artery was not a correlate for long-term mortality. CONCLUSIONS: Patients undergoing reoperative procedures have higher mortality initially and at long term than patients undergoing a first procedure. Expected mortality based on covariates may help in the decision of whether to perform reoperative coronary artery bypass graft surgery.

Age Factors↗
PubMed1992

Reoperation, emergency and urgent open cardiac surgery in Jehovah's Witnesses.

Progressive advances in perfusion technology and perioperative supportive management have made it possible for members of the Jehovah's Witnesses religious group to undergo open cardiac operations with remarkable safety. However, hospital mortality remains high in (1) patients requiring reoperation (in whom both technical and bleeding problems tend to be more frequent) and (2) patients with significantly compromised cardiac performance requiring urgent or emergency operation. Employing a number of perioperative measures designed to minimize blood loss and maintain hematocrit levels (including use of the recently available recombinant human erythropoietin in two patients whose cases are reported herein), 13 reoperations and five urgent or emergency operations were performed. The one death in the entire series occurred in a patient (reoperation group) who died of a cerebrovascular accident of presumed embolic etiology, having undergone combined debridement of a stenotic heavily calcified aortic valve and a second coronary artery revascularization procedure. None of the patients required surgical exploration for bleeding. We suggest that currently available methodology permits Jehovah's Witnesses to undergo reoperation, emergency surgery, or urgent open cardiac operation at a level of risk not dissimilar to that seen in patients who permit use of homologous blood and products in their treatment.

Adult↗
PubMed1999

Long-term follow-up after coronary artery bypass grafting reoperation.

BACKGROUND: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. OBJECTIVE: To determine the clinical outcome and the long-term results of a second CABG. SETTING: An 1100-bed urban university-affiliated hospital. DESIGN: Retrieval of data on selected parameters from medical records before surgery and prospective follow-up afterwards. PATIENTS AND METHODS: We studied the outcomes of 498 consecutive patients who underwent CABG reoperation in our institution from January 1978 to December 1989 and who were followed postoperatively. Their perioperative mortality, morbidity, and long-term follow-up results were re-evaluated. The end points of the study were December 1997, 15 years of follow-up, or the patient's death. RESULTS: The perioperative mortality rate was 3%. The cumulative survival rates were 90.1%, 74%, and 63.4% at the 5-year, 10-year, and 15-year follow-ups, respectively. The cardiac event-free survival rates were 91.5%, 83.4%, and 67.8% at the 5-year, 10-year, and 15-year follow-ups, respectively. The risk factors adversely affecting long-term survival were advanced age, hypertension, and a low left ventricular ejection fraction (LVEF). CONCLUSIONS: The long-term results of cumulative survival and cardiac event-free survival in patients who underwent CABG reoperation are good. Although this reoperation is safe overall, advanced age, hypertension, and a decreased LVEF significantly increase the surgical risk.

Adult↗
PubMed2005

Operative mortality after valvular reoperations.

BACKGROUND: To determine the incidence and risk factors of mortality and morbidity in valvular reoperations. METHODS: Between January 1993 and December 2003, 309 valvular reoperations were performed. The reasons for reoperations were reconstructive surgery in first operation (110 patients, 35.5%), prosthetic valve endocarditis (12 patients, 3.8%), periprosthetic leakage (32 patients, 10.3%), new valve degenerations (12 patients, 3.8%), bioprosthetic dysfunction (92 patients, 29.7%), acute thrombotic stuck valve (30 patients, 9.7%), and pannus formation (21 patients, 6.7%). Mitral valves were replaced in 235 patients, aortic valves were replaced in 32 patients, 24 patients had aortic and mitral valve replacements, 2 patients had mitral and tricuspid valve replacements, and reconstruction of periprosthetic leakage was held in 16 patients. 264 patients had elective surgery, whereas 45 were operated on emergency basis. RESULTS: Hospital mortality was 14.23%. Mortality rate was found to be 10.6% for elective cases and 35.5% for emergency cases. Permanent pacemaker was required in 12 patients, 3 patients had cerebrovascular events, and mediastinitis was observed in 1 patient. Multivariate analysis demonstrated that age > 60 (P = .006; OR 7.3, 95% CI 1.7-30.1), emergency surgery (P = .001; OR 8.1, 95% CI 2.4-27.7), preoperative cerebrovascular accident (P = .003; OR 11.8, 95% CI 2.458.7), and concomitant ascending aorta replacement (P < .001; OR 27.4, 95% CI 6-127) were independent risk factors. CONCLUSION: Valvular reoperations can be carried out with acceptable morbidity and mortality in elective operations but mortality rates are still very high in emergent cases.

Adult↗
PubMed1991

Reoperation in high ulnar neuropathy.

Twenty-two reoperations were done on 16 arms in 14 patients who had previously been unsuccessfully treated by neurolysis for cubital tunnel syndrome. For the first reoperation subcutaneous transposition was chosen for 10 arms, and submuscular transposition for six. The symptoms were cured or improved in seven arms, eight were unchanged and one was made worse. In six arms in which first neurolysis and then subcutaneous transposition had been unsuccessful, submuscular transposition was carried out. Five patients were improved or cured, and the symptoms were unchanged in one. Reoperation after ulnar neurolysis therefore gave satisfactory results in about half the cases. Submuscular transposition carried out as a second reoperation may be useful in cases in which subcutaneous transposition had not been successful.

Adolescent↗