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At least 451 records · Page 25Linked to original sources
PubMed1988

Coronary artery reoperations. Early and late results in 101 patients.

Coronary artery reoperation was performed on 101 patients between 1972 and 1985. The resternotomy was associated with major hemorrhage in 12 cases. Of 29 patent internal mammary artery (IMA) grafts, 11 (38%) were damaged during mobilization of the left ventricle. At reoperations performed more than a year after the initial operation, increased graft blood flow compared with the first operation was observed in IMA but not in vein grafts. There were six early deaths (6%). The 5-year survival rate, inclusive of early mortality, was 90%. After a median of 2.5 years, 82% of the patients reported symptomatic improvement and 22% were completely free from angina, but full physical fitness was restored in only 3%. Excluding the patients of retirement age, 35% were able to resume work after the reoperation. Coronary artery reoperation should be considered only for patients with severe angina, because of the increased surgical risk and the lower likelihood of completely relieved symptoms. Presence of a patent IMA graft necessitates special caution.

Angina Pectoris↗
PubMed1989

Microsurgical reoperation following lumbar disc surgery. Timing, surgical findings, and outcome in 92 patients.

Ninety-two patients who underwent microsurgical reoperation for persistent or new complaints following initial lumbar intervertebral disc surgery were evaluated retrospectively. Sixty percent of all pain relapses occurred within 1 year following the first operation; thereafter, the probability of a relapse declined steadily and was as low as 0.1% per year between 5 and 20 years. The results of microsurgical reoperation in terms of pain relief and working capability were considered "excellent" in 22% of patients, "good" in 30%, and "satisfactory" in 29%. Thus, 81% of the patients could be considered as treated successfully and in 19% the result was not successful. The most common intraoperative findings were: a true recurrence at the same level in 43% of cases, a new herniation at another level in 15%, and a small recurrent fragment embedded in epidural fibrosis in 23%. Five percent of patients had severe epidural fibrosis as the only pathology. In 15%, reoperation was performed within 1 month to treat persisting pain, and either a missed disc fragment, an inadequately decompressed lateral recess, or an unrecognized second-level disc protrusion was found. The clinical outcome is affected predominantly by the intraoperative pathology and the time interval between the first and second operation. An excellent or good outcome was usually achieved in patients with a recurrence of pain after 1 year resulting from a true recurrent disc or a new herniation at another level. In contrast, very unfavorable results were noted with most reoperations performed during the 1st year when extensive epidural fibrosis (or fibrosis with a small recurrence) was present.

Adult↗
PubMed1995

Reoperative management of intracranial aneurysms.

Nineteen patients underwent 20 operative procedures for the treatment of recurrent or residual aneurysms. There were 13 small, three large, and four giant lesions; with one exception, all were in the anterior circulation. Five individuals presented with recurrent subarachnoid hemorrhage, six were referred for symptoms of mass effect, and nine were known to have had inadequate treatment at the time of the initial operative procedure. The average time interval from initial treatment to either recurrent subarachnoid hemorrhage or compressive effects was 10.5 and 9.75 years, respectively. No deaths resulted from the reoperative procedures. Two patients suffered moderate disability and one had severe disability. Malpositioned or slipped clips, intraoperative rupture, and inadequate exposure were responsible for 75% of the initial operative failures. The technical difficulty of the reoperative procedure correlated with the length of time between initial and reoperative treatment, the presence of clips and coating agents, and the complexity of the lesion. A classification scheme for preoperative planning and case selection is proposed based on the technical adjuncts required for reoperative aneurysm procedures.

Aneurysm, Ruptured↗
PubMedDate not supplied

Reoperation rate in adjustable strabismus surgery.

Adjustable suture strabismus surgery may reduce the frequency of reoperations by reducing immediate postoperative over- and undercorrections. We reviewed 290 strabismus procedures performed with an adjustable suture technique. Thirty-five patients required additional surgery, for a reoperation rate of 9.7%. Reoperation frequencies for patients undergoing non-adjustable procedures average approximately 20% in our experience and in reported series. Our low reoperation rate with adjustable strabismus surgery supports our clinical impression that more accurate results are possible with this technique in appropriate patients.

Adolescent↗
PubMed1999

Preservation of the recurrent laryngeal nerves in thyroid and parathyroid reoperations.

BACKGROUND: The recurrent laryngeal nerve (RLN) is vulnerable to injury in thyroid and parathyroid reoperations because of the presence of scar tissue and displacement of the nerve from its normal position. METHODS: Since 1993, we have performed 132 reoperations for recurrence of thyroid or parathyroid carcinoma (102 cases), persistent hyperparathyroidism (21 cases), and recurrent goiter (9 cases). One or both RLNs were identified in all cases (208 nerves). Exposure of the nerve was accomplished by a lateral approach (159 nerves), a low anterior approach (41 nerves), or the identification of the nerve between the larynx and the upper pole of the thyroid, in parathyroid reoperations (8 nerves). Dissection was then done while the nerve was kept in view at all times. RESULTS: Preoperatively, unilateral vocal cord paralysis was noted in 6 patients. Resection of a functioning RLN encased with a tumor was intentionally carried out in 5 patients. The RLNs were identified and preserved in all other cases. Among these 121 patients, transient hoarseness lasting up to a month occurred in 12 patients. CONCLUSIONS: Careful identification and exposure of the RLN through a previously undissected area can be done safely in thyroid and parathyroid reoperations and resulted in no permanent recurrent nerve injuries in our experience.

Follow-Up Studies↗
PubMed2000

Early and late results of mitral valve repair for mitral valve regurgitation. Significant risk factors of reoperation.

BACKGROUND: Mitral valve repair for mitral valve regurgitation has many advantages over mitral valve replacement. However, durability and reoperation after mitral valve repair still remain major problems. We examined the outcome of mitral valve repair for mitral valve regurgitation and analyzed several pre- and intraoperative potential risk factors to determine the significant risk factors of reoperation. METHODS: From February 1981 to November 1996, 86 patients underwent mitral valve repair for mitral regurgitation or combined mitral regurgitation and stenosis. The mean age was 53 years, and 88.4% were New York Heart Association class III or IV. The causes of mitral valve disease were degenerative disease in 53 patients, rheumatic disease in 15, infective endocarditis in 11, and ischemic disease in 7. There were 2 early and 8 late deaths. RESULTS: Actuarial overall survival including early death at 10 years was 83.2+/-6.1%, freedom from reoperation was 86.8+/-5.3%, freedom from thromboembolism was 90.9+/-6.2%, and freedom from infective endocarditis was 98.5+/-1.5%. There was no bleeding event. At the last follow-up, most patients were in New York Heart Association class I or II. Prolapse of anterior leaflet and rheumatic mitral regurgitation were identified as independent predictors for reoperation. CONCLUSIONS: The repair techniques for anterior leaflet prolapse and patient selection in rheumatic mitral disease are important for improving long-term results of mitral valve repair for mitral regurgitation.

Adolescent↗
PubMed2000

Reoperative coronary artery bypass grafting without cardiopulmonary bypass.

Conventional reoperative coronary artery bypass grafting (CABG) is associated with increased surgical risk. The use of less invasive methods to perform myocardial revascularization may, therefore, be more suitable, especially for high-risk patients. In June 1999, we performed three reoperative CABG surgeries, without the use of cardiopulmonary bypass, through unilateral or bilateral thoracotomy. One patient had single-vessel disease and the other two had multiple-vessel disease. All three patients had uneventful postoperative recovery. During early postoperative follow-up, all three patients were angina-free and were in New York Heart Association functional class I. The results of these three cases suggest that minimally invasive reoperative CABG may reduce morbidity compared with conventional reoperative CABG.

Aged↗
PubMed2000

Inguinal reoperation for undescended testis and hernia: approach to the spermatic cord through the cremaster fascia.

PURPOSE: Reoperation of the inguinal canal is difficult with few available lucid descriptions of the technique. We reviewed our experience with a unique surgical approach to the spermatic cord through the cremaster fascia in patients who had undergone previous operations for undescended testis or hernia and report its outcome. MATERIALS AND METHODS: A total of 54 inguinal reoperations were performed in 45 boys with an undescended testis or indirect inguinal hernia using a unique surgical approach through the cremaster fascia. RESULTS: Of the 54 inguinal canal reoperations surgery was successful in all but 1 patient who sustained a transected vas deferens (1.8% complication rate). CONCLUSIONS: The surgical approach to the inguinal canal through the cremaster fascia is an effective technique for reoperation of the inguinal canal after orchiopexy or hernial repair.

Adolescent↗
PubMed2001

Aortic valve reoperation after homograft or autograft replacement.

BACKGROUND AND AIM OF THE STUDY: With increasing use of homograft and autograft aortic valves for aortic valve replacement (AVR), more patients will be presenting for aortic valve reoperation due to structural degeneration of the homograft or autograft valve. Management options include homograft re-replacement, which may require extensive surgery, versus AVR with a mechanical valve or a stented xenograft. Here, results are reported in 18 consecutive patients who underwent aortic valve re-replacement (AVreR) after previous homograft or autograft insertion. METHODS: Between May 1976 and March 2001, 18 patients underwent AVR after previous homograft (n = 16) or autograft (n = 2) insertion. The homograft or autograft had been implanted as a full root in eight patients (44%), as a mini-root in one (6%), and in the subcoronary position in nine (50%). Indication for the reoperation was structural valve degeneration (n = 14; 72%) in one occasion combined with aneurysm of the homograft, or endocarditis (n = 4; 22%), and seven (39%) presented as a non-elective procedure. The median interval between the two operations was 5.4 years (range: 0.3-10.8 years). RESULTS: Fourteen patients (78%) received either a mechanical valve (n = 12; 67%) or a stented xenograft valve (n = 2; 11%). Four others (22%) required root re-replacement with either another homograft (n = 3) or a mechanical valved conduit (n = 1) for endocarditis (n = 2) or an associated aneurysm (n = 2). Overall hospital mortality was 11% (n = 2) due to stroke (n = 1) or respiratory failure (n = 1). Two patients died 3.1 and 7.0 years after the procedure. CONCLUSION: Aortic valve reoperation after previous homograft or autograft implantation is a rare operation and presents a high-risk group. A simplified approach was preferred by utilizing mechanical or stented xenograft valves at reoperation, while homograft re-replacement was reserved for endocarditis or an associated aneurysm.

Adult↗
PubMed2001

[Coronary reoperation: a 16 years retrospective analysis].

BACKGROUND: Coronary artery bypass grafting (CABG) reoperation is being performed with increasing frequency. AIM: To assess the early and long term results of coronary reoperations in our institution and to identify prognostic factors. PATIENTS AND METHODS: 214 patients subjected to coronary reoperations between 1983 and 1999 were retrospectively studied. RESULTS: Mean age was 64.2 years (range 42-79 years), 202 (94.4%) were male and 12 (5.6%) female. The mean interval between the operations was 125.7 months (range 6-252 months). 10 (4.6%) were emergency surgeries. Overall operative mortality was 5.6% (11 deaths) and in 5 patients (3.4%) a perioperative myocardial infarction was noted. Univariate analysis identified moderate or severe left ventricular failure (p = 0.048) as predictor of increased operative mortality, meanwhile age over 75 years (p = 0.02) and moderate or severe left ventricular failure (p = 0.01) were identified as predictors of increased in hospital mortality in the multivariate analysis. Follow up of in hospital survivors (mean interval 65 months, range 4 to 190 months) documented a 5 years survival rate of 82.9%, a 10 years survival rate of 73.1% and a 15 years survival rate of 53.4%. Moderate or severe left ventricular failure (p < 0.0001) and emergency surgeries (p = 0.007) were identified as factors influencing the late survival in the stepwise logistical regression analysis. Multivariate analysis identified left ventricular failure (p = 0.01) and peripheral vascular disease (p = 0.01) as predictors of decreased late survival. CONCLUSIONS: Coronary reoperation has a low mortality in patients with a normal ventricular function and also has an excellent overall and disease free survival in the first 10 years of follow up. Left ventricular function is an independent risk factor increasing in hospital and late mortality.

Adult↗
PubMed2002

[Reoperation for metachronous pulmonary or tracheal lesions after pneumonectomy].

Although aggressive reoperation for metachronous multiple primary lung cancer or intrathoracic recurrence without distant metastases have been recommended to the patients of primary lung cancer and metastatic lung tumor, surgical indication after a previous pneumonectomy is restricted because of residual pulmonary function. We report about 3 reoperated cases for metachronous pulmonary or tracheal lesions after left pneumonectomy. Case 1: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for tracheal cancer 41 months after the pneumonectomy. Case 2: A 61-year old male who underwent left pneumonectomy for primary lung cancer was reoperated for metachronous multiple primary lung cancer 59 months after the pneumonectomy. Case 3: A 59-year old male who underwent left pneumonectomy for metastatic lung tumor from rectal cancer was re-operated for intrathoracic recurrence 28 months after the pneumonectomy. All cases are alive without recurrence.

Humans↗
PubMed1998

[Reoperation for recurrent carcinoma of the esophagus and cardia].

OBJECTIVE: To review the experience of reoperation for recurrent carcinoma of the esophagus and cardia. METHOD: Between 1979 and 1996, 44 patients with recurrent esophageal and cardiac cancer after the first operation underwent reoperation. Among them, 21 had esophageal cancer and 23 cardiac cancer. 36 patients were male and 8 female, with age ranged from 42 to 68 years. RESULT: The resectability rate was 77.2% (34/44) and the hospital mortality rate was 5.8%. Postoperative complications occurred in 7 patients with a morbidity of 20.5%. Pathologically, previous anastomotic relapse was seen in 26 patients, recurrent lesion of residual esophagus in 7, and recurrent cancerous residue at the esophageal bed in 1. 15 patients (44%) showed lymph node metastasis. Follow-up showed that 4 patients survived for 5 years, 4 for 3 years, and 3 for 2 years. 15 patients died within one year after reoperation. CONCLUSION: The recurrence of esophageal and cardiac cancer after first operation is not a contraindication to reoperation, but careful preoperative assessment and patients' selection should become an integral part of the evaluation of these patients.

Adult↗
PubMed2002

Minimally invasive surgical techniques in reoperative surgery for gastroesophageal reflux disease in infants and children.

Fundoplication is commonly performed in children suffering from complications of gastroesophageal reflux disease (GERD). Recently laparoscopic fundoplication has become a standard of care for GERD in children. Published reports show that 2.3 to 14 per cent of children require reoperation after failed fundoplication. The purpose of this study is to show the feasibility of minimally invasive surgical (MIS) techniques to treat children after failed fundoplication. A retrospective chart review was performed for all patients who underwent laparoscopic redo fundoplication at Children's Healthcare of Atlanta at Egleston from July 1998 to July 2000. The patients' records were reviewed for age, diagnosis, type and time of initial operation, type and time of redo operation, operative time for redo operation, and complications. Seventeen children (age 3 months to 18 years) had operations for failed fundoplication attempted using MIS techniques. Six of these children were referred after their initial operation performed elsewhere. Nine (53%) were neurologically impaired. Ten (59%) have respiratory complications of GERD. The initial procedures were as follows: One open Nissen fundoplication, two open Thal fundoplications, 13 laparoscopic Nissen fundoplications, and one laparoscopic Toupet fundoplication. The reoperative procedures performed were revision of fundoplication and hiatal hernia repair (13) or hiatal hernia repair only (four). Two patients had concurrent gastric emptying procedures. One procedure was converted to open for technical reasons. One patient developed a pelvic abscess secondary to leakage around the gastrostomy tube. One child had erosion into the esophagus of a Dacron patch that was used to close a large hiatal defect. Thirteen patients began feeding by the first postoperative day. We conclude that MIS techniques can be applied to reoperative surgery for the treatment of GERD with an acceptable complication rate in this difficult group of patients. Reoperative patients appear to have the same benefits from MIS as patients undergoing their initial procedure.

Child↗
PubMed2003

Does reoperation predispose to postoperative wound infection in women undergoing operation for breast cancer?

Reoperations for breast cancer predispose to a higher risk of postoperative wound infections than primary procedures. We accomplished a retrospective chart review of 320 women who underwent multiple breast cancer procedures between 10/97 and 8/02. The mean number of procedures was 2.4 (range, 2-5). The overall incidence of wound infection was 6.1 per cent. Wound infections developed, on average, 12 days after surgery (range, 2-30). There was a statistically significant difference in the incidence of wound infection comparing the initial procedure versus the subsequent operation (1.6% vs. 9.4%, P < 0.001). This was also seen with reoperation after an operative biopsy compared to operation after a core biopsy (11.1% vs. 9.7%, P < 0.01). The incidence was increased to 22.0 per cent when the initial operation involved lymph node dissection (sentinel lymph node biopsy or complete axillary lymph node dissection). Wire localization did not increase the incidence of postoperative wound infections, and prophylactic antibiotics were associated with a decreased incidence of wound infection in the reoperative setting. The incidence of wound infection is increased with reoperation after operative biopsy compared to operation after core biopsy and is further increased when the initial biopsy involved lymph node dissection.

Antibiotic Prophylaxis↗
PubMed1992

[Study on reoperation in cardiac disease].

Between January in 1988 and September in 1990, 65 patients underwent reoperation for acquired heart disease. Previous operations were closed mitral commissurotomy in 19, open mitral commissurotomy in 19, mitral valve replacement in 22, aortic valve replacement in one, and mitral repair in 4. After median sternotomy performed by hand-operated chisel and hammer, minimized dissection of the adhesive lesion was achieved. During the sternotomy, two patients required additional right thoracotomy because of marked median sternal adhesion and major cardiovascular injury occurred in three patients. Cardioplegic solution was introduced in normograde fashion except in two patients. In two patients with previous MVR by porcine prosthesis severe calcification was found in the left atrial wall and the prosthesis was not removed in one. Postoperative complications were low cardiac output syndrome requiring intra-aortic balloon pumping in two, re-thoracotomy due to hemorrhage in one, and mild air embolism without neurological damage in two. There was one early death (1.5%) but no late death. Although perioperative complication seemed to increase in reoperation, post-reoperative results was as good as those in the primary cardiac operation and reoperation on cardiac surgery should be performed before losing the indication for operation.

Adult↗
PubMed2004

The risk of reoperative heart valve procedures in Octogenarian patients.

BACKGROUND AND AIM OF THE STUDY: The authors' experience is reported of cardiac reoperations for valvular heart disease in octogenarian patients. METHODS: The records of 22 consecutive patients (10 men, 12 women) aged > or =80 years (mean age 82.4+/-2.3 years) who underwent cardiac reoperation for aortic and/or mitral valvular heart disease at the authors' institution between 1991 and 2001 were retrospectively reviewed. RESULTS: Indications for reoperation were structural dysfunction of a previously implanted bioprosthetic valve in 11 patients (50%), new valvular heart disease in six (27%), progression of rheumatic valvular heart disease in four (18%), and prosthetic valve infective endocarditis in one patient (5%). Fourteen patients (64%) underwent isolated aortic valve replacement (AVR), two (9%) had AVR plus coronary artery bypass grafting (CABG), one patient (5%) had aortic root replacement plus CABG, three patients (14%) had isolated mitral valve replacement (MVR), one patient (5%) had MVR plus ascending aorta replacement, and one (5%) had AVR plus MVR. Postoperative complications occurred in 18 patients (82%). The hospital mortality rate was 32%. Actuarial survival estimates at one year, and at three and five years were 62.6%, 56.3% and 40.2%, respectively. CONCLUSION: Cardiac reoperations for valvular heart disease in octogenarians carry a high postoperative morbidity and mortality. These findings must be taken into account in the management of associated mild or moderate valvular heart disease, and in the choice of heart valve prosthesis at the initial operation in younger patients.

Aged↗
PubMed2004

[Reoperations following laparoscopic fundoplication].

During an eight-year-period, 623 laparoscopic fundoplications were conducted in the Surgical Clinic in Olomouc. Out of the total number, 14 of them were reoperations and 4 reoperations were conducted on patients, primarily operated in other clinics. 9 patients were reoperated for dislocations of the rim transhiatally into the mediastinum, respectively aborally to the gastric fundus. 4 patients were operated for oesophageal constricions in the hiatus region and 2 patients for haemoperitoneum caused by haemorrhaging from a wound after the port removal. The remaining 3 patients had the reoperation indicated for a biliary reflux in the oesophageus, the rim loosening or for a non-standard primary procedure, conducted to treat the oesophageal reflux disorder in another clinic. This study discusses causes of individual complications and their treatment alternatives. The authors point-out prevention of complications based on following certain principles during the laparoscopic fundoplication procedures.

Fundoplication↗